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2009 OKLAHOMA HIV/STD COMPREHENSIVE EPIDEMIOLOGIC PROFILE
To obtain a free copy of this report or to request additional HIV/STD data, please contact:
Oklahoma State Department of Health
HIV/STD Service
1000 NE 10th, MS 0308
Oklahoma City, OK 73117
Phone: (405) 271‐4636
Fax: (405) 271‐1187
Service Chief: Jan Fox, MPH, RN
The Oklahoma State Department of Health (OSDH) is an Equal Opportunity Employer. This publication,
printed by the OSDH, was issued by the OSDH as authorized by Terry Cline, PH.D., Commissioner of
Health. 150 copies were printed in January 2011 at a cost of $3,070.50. Copies have been deposited with
the Publications Clearinghouse of the Oklahoma State Department of Libraries.
CONTRIBUTING AUTHORS:
Terrainia Harris, MPH
Manager of Surveillance and Analysis Office
Sam Nimo, MPH
Epidemiologist
Martin Lansdale, MPH
Epidemiologist
Kristen Eberly, MPH
Director of Prevention and Intervention
Brittney Wigley, MS
Manager of Prevention Quality Assurance and Analysis
Nicole Diehl, MA
Manager, Care QA and Data Analysis
Janet Wilson, RN, MPH
Adult Viral Hepatitis Prevention Coordinator
Ayesha Lampkins, MPH, CHES
Oklahoma City Frontline Disease Intervention Supervisor
EDITORS:
Terrainia Harris, MPH
Olivia Scott
Brittney Wigley, MS
Kristen Eberly, MPH
Sally Bouse‐Pittser, MPH, CHES
Raymond Dallas, MPH, CHES
Debbie Purton, RN, MPH
Lynne Davis
Sam Nimo, MPH
Nicole Diehl, MA
Cover Art Design: Olivia Scott
The HIV/STD Service Surveillance and Analysis Office would like to acknowledge those programs that have
provided data for this document, as well as persons who have helped organize, review, and edit this document.
The collaboration between the HIV/STD Service Prevention and Intervention Division, HIV/STD Service Care and
Delivery Division, and HIV/STD Viral Hepatitis Office has strengthened this publication for our state.
INTRODUCTION
Executive Summary 1
Commonly Used Epidemiologic Terms 3
SECTION 1 8
Oklahoma Population and Demographics 9
SECTION 2 14
Cumulative HIV/AIDS Cases in Oklahoma 15
Living HIV/AIDS Cases in Oklahoma 19
New HIV/AIDS Cases in Oklahoma for 2009 23
SECTION 3 28
Men Who Have Sex with Men 29
Injection Drug Users 33
Females Age 13 and Above 37
SECTION 4 42
Ryan White Care Services in Oklahoma 43
HIV Prevention in Oklahoma 47
HIV Counseling, Testing, and Referral Services 49
SECTION 5 52
Unmet Need in Oklahoma 53
SECTION 6 56
Chlamydia in Oklahoma 57
Gonorrhea in Oklahoma 61
Antibiotic Resistant Gonorrhea 65
Syphilis in Oklahoma 67
Syphilis Outbreak Among Teens 71
HIV and Syphilis Co‐infection 73
Hepatitis B in Oklahoma 75
Hepatitis C in Oklahoma 77
HIV and Hepatitis Co‐Infection 79
TABLES, CHARTS, and GRAPHS 82
MAPS 118
HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immune
Deficiency Syndrome). AIDS is the result of a HIV infection; the term AIDS applies to
the most advanced stage of HIV infection. In Oklahoma, AIDS as a syndrome,
became reportable in 1983 and HIV infection in 1988.
HIV damages a person’s body by destroying specific blood cells, called CD4 positive T‐lymphocytes
(CD4+ T cells), which are crucial to helping the body fight diseases.
People living with HIV may appear and feel healthy for several years, while HIV is still
affecting their bodies.
AIDS is defined as having HIV with fewer than 200 CD4+ T cells per cubic milliliter of
blood, and/or any one of 26 clinical opportunistic conditions which affect those with
compromised immune systems. Before the development of highly active
antiretroviral therapy (HAART), people with HIV often progressed to AIDS in just a
few years. Currently, people are living much longer ‐ even decades ‐ with HIV before
developing AIDS.
At the end of 2009, an estimated 8,181 cases of HIV/AIDS had been diagnosed in
residents of Oklahoma, 5,335 AIDS and 2,846 HIV. Of these cases, 5,320 (65%) were
diagnosed among Whites; 1,703 (20.8%) among Black/African Americans; 469 (5.7%)
among Hispanics; 42 (0.5%) among Asian/Hawaiian Pacific Islanders; and 522 (6.4%)
among American Indian/Alaskan Natives. Persons who reportedly belonged to two or
more races accounted for 125 (1.5%) of the cases diagnosed. By the end of 2009,
3,257 cases were known to have died.
The ratio of males to females diagnosed was 6:1 (6,981, 85.3% to 1,200, 14.7%)
respectively. Those reporting a risk of males having sex with males (MSM)
represented 52.7% (4,311) of cases, while MSM and intravenous drug use
(MSM/IDU) represented 10.5% (857). Over 11% reported a risk of intravenous drug
use (IDU). About 11.2% (919) were exposed via heterosexual contact.
Among age groups, ages 30‐39 years accounted for the largest proportion of cases
(38.5%; 3,151), followed by 20‐29 years with 31.3% (2,563). Teenagers 13‐19 years of
age accounted for a total of 2.7% (217) of cases, while children under the age of 13
years accounted for 0.8% (64) of the 8,181 cases.
In 2009, 312 cases of HIV/AIDS were diagnosed in Oklahoma. This was a 9%
decrease in the number of cases diagnosed since 2008. Although there was
approximately a 26% decrease in the number of newly diagnosed AIDS cases from
1999 to 2009, there has been a 49% increase in the number of newly diagnosed HIV
cases.
AIDS was first
reported in the
United States in
1981.
In Oklahoma, two
cases of AIDS
were first
diagnosed in
1982 and two
cases of HIV in
1984.
1
HIV/STD Service
Oklahoma State
Department of Health
Of the 312 cases diagnosed, males reported 255 cases with a rate of 14.2 per
100,000 population, while females reported 57 cases with a rate of 3.1 per 100,000
population. During 2009, three counties in Oklahoma accounted for about 61% of
the cases—Oklahoma, Tulsa, and Cleveland counties with 32.7% (102), 21.8% (68),
and 6.4% (20) respectively.
Of the 312 cases, 136 (43.6%) reported their risk as MSM and 11 (3.5%) reported
their risk as MSM/IDU. Eighteen (5.8%) persons reported their risk as IDU only.
Forty‐four (14.1%) persons were infected through heterosexual contact. More than
one quarter of those diagnosed in 2009 did not report a risk.
2
Following is a list of definitions and commonly used epidemiologic terms.1
Note: the numbers given in the examples are for illustrative purposes only.
AIDS: (acquired immunodeficiency syndrome): An HIV‐infected person receives a
diagnosis of AIDS after the development of one of the CDC‐defined AIDS indicator
illnesses (see opportunistic infection) or on the basis of the results of specific blood tests
(i.e., a CD4+ count of less than 200 cells/microliter or a CD4+ percentage of less than 14).
A positive HIV test result does not mean that a person has AIDS.
Case: A condition, such as HIV infection (e.g., an HIV case) or AIDS (e.g., an AIDS case)
diagnosed according to a standard case definition.
Cumulative Cases: The total number of cases of a disease reported or diagnosed during a
specified time. Cumulative cases can include cases in people who have died.
Denominator: Divisor; the term of a fraction, usually written under or after the line that
indicates the number of equal parts into which the unit is divided; used to calculate a rate
or ratio. For example, in the fraction ¾, four is the denominator.
Epidemiology: The study of the distribution and determinants of health‐related states or
events in specified populations, and the application of this study to control health
problems.
Exposure: Contact with a source of a disease agent in such a manner that effective
transmission of agent may occur.
Exposure Category: The exposure mode indicates which risk behavior had the highest
probability of being the route of infection. For surveillance purposes, HIV infection cases
and AIDS cases are counted only once in a hierarchy of exposure modes. The hierarchy
was developed by CDC to predict the most likely cause of infection when a person has
engaged in multiple risky behaviors. Note that the hierarchy is based on the likelihood of
transmission given a single instance of the risky behavior, and any occurrence of the
behavior since 1978 counts. The hierarchy has been criticized because how often or how
recently people have put themselves at risk (or been put at risk) are not taken into
account. Some exposure modes, such as Pediatric and Blood/Blood Products are not risk
behaviors on the part of the infected individuals.
Persons with more than one reported mode of exposure to HIV are classified in the
exposure category listed first in the hierarchy, except for men with both a history of
sexual contact with other men and injection drug use. They make up a separate
exposure category.
CDC
Centers for
Disease Control
and Prevention
HRSA
Health Resources
and Services
Administration
ACRF
Adult Case
Report Form
DIS
Disease
Intervention
Specialist
1Last, John M. A Dictionary of Epidemiology. 4th Ed. New York: Oxford University Press, Inc., 2001.; Centers for Disease Control
and Prevention and Health Resources and Services Administration. Integrated Guidelines for Developing Epidemiologic Profiles: HIV
Prevention and Ryan White CARE Act Community Planning. Atlanta, Georgia: Centers for Disease Control and Prevention; 2004.
3
HIV/STD Service
Oklahoma State
Department of Health
Following is a description of the Exposure Mode categories in the hierarchical order:
 MSM (Male to Male Sex): Includes men who report sexual contact with other
men, and men who report sexual contact with both men and women.
 IDU (Injection Drug Use): Cases in persons who report injection drug use.
 MSM & IDU: Cases in men who report both injection drug use and sexual contact
with other men.
 Heterosexual Sex: Cases in persons who report specific heterosexual sex with a
person with, or at increased risk for, HIV infection (e.g. an injection drug user).
 Pediatric: Infection before the age of 13, including mother to child transmission
through pregnancy, childbirth, or breastfeeding, and blood transfusions to
children.
 No Identified Risk: Cases in persons with no reported history or unknown history
of exposure to HIV through any of the listed exposure categories.
HIV: Human Immunodeficiency Virus (HIV) is the virus which causes AIDS. HIV is a virus
that kills the body’s CD4 cells. CD4 cells help a body fight off infection and disease.
Incidence: The number of new cases in a defined population during a specific period,
often a year, which can be used to measure disease frequency. It is important to
understand the difference between HIV incidence and reported HIV diagnoses. While
trends in HIV diagnosis are our best indicator for who is most at risk for HIV infection, HIV
surveillance reflects the incidence of diagnoses among people who are in care and not the
actual incidence of new infections. Like AIDS diagnoses, HIV diagnoses are not a direct
measure of incidence of infection itself. People may be infected with the virus for many
years prior to being tested and seeking care, at which point the case is considered a
“diagnosis” and reported to the Oklahoma State Department of Health HIV/AIDS
Surveillance system.
Incidence Rate: The number of instances (new cases) of illness commencing, or persons
falling ill, during a given period in a specified population. Incidence rate is calculated by
dividing incidence during a specified period of time by the population in which cases
occurred. A multiplier is used to convert the resulting fraction to a number over a
common denominator (often 100,000).
Morbidity: The presence of illness in the population.
Mortality: The total number of persons who have died of the disease of interest, usually
expressed as a rate. Mortality (total number of deaths over the total population)
measures the effect of the disease on the population as a whole.
4
Mortality (Death) Rate: An estimate of the portion of a population that dies during a
specified period of time.
No Identified Risk (NIR): Cases in which epidemiologic follow‐up has been conducted and
sources of data have been reviewed, which may include an interview with the patient or
provider, and no mode of exposure has been identified. Any case that continues to have
no reported risk for 12 or more months after the report date is considered NIR.
Numerator: Dividend, the term of a fraction, usually written above or before the line that
indicates the number of parts that are to be divided, used to calculate a rate or ratio. For
example, in the fraction ¾, three is the numerator.
People Living with HIV/AIDS: Includes all persons not known to be dead and who have
ever been diagnosed with HIV infection and/or AIDS, regardless of their current clinical
status. Only people who have been reported to the Oklahoma State Department of
Health HIV/AIDS Surveillance system are included in counts.
Percent Increase or Decrease: The rate of change between one time period and another
earlier time period. For example, if 60 AIDS cases were diagnosed in 1992 and 80 were
diagnosed in 1995, the calculation looks like this:
80 – 60 = 20 20 ÷ 60 = 0.33 0.33 X 100 = 33%
Therefore, the number of cases increased 33% from 1992 to 1995.
Note: You can have large percentage increases but you can never have a decrease of over
100%.
Perinatal Transmission: HIV transmission from mother to child during pregnancy, labor
and delivery, or breastfeeding.
Prevalence: The number of instances of a given disease or condition, in a given
population at a designated time (e.g. the number of total living HIV).
Proportion/Percentage: A type of ratio in which the numerator is included in the
denominator. The ratio of a part to a whole, expressed as a decimal fraction (e.g. 0.2), as
a vulgar fraction (e.g. 1/5), or as a percentage (e.g. 20%).
Rate: A measure of the frequency of occurrence of a phenomenon. The use of rates
rather than raw numbers is essential for comparison of experiences between populations
at different times, different places, or among different classes of persons. The
components of a rate are the numerator, the denominator, the specified time in which
events occur, and a multiplier (usually a power of 10).
Rate 􀵌
􀜰􀝑􀝉􀜾􀝁􀝎 􀝋􀝂 􀝁􀝒􀝁􀝊􀝐􀝏 􀝅􀝊 􀜽 􀝏􀝌􀝁􀜿􀝅􀝂􀝅􀝁􀝀 􀝌􀝁􀝎􀝅􀝋􀝀 􀝋􀝂 􀝐􀝅􀝉􀝁
􀜣􀝒􀝁􀝎��􀝃􀝁 􀝌􀝋􀝌􀝑􀝈􀜽􀝐􀝅􀝋􀝊 􀝀􀝑􀝎􀝅􀝊􀝃 􀝌􀝁􀝎􀝅􀝋􀝀 􀝋􀝂 􀝐􀝅􀝉􀝁
􀝔 100,000
HAART
Highly Active
Antiretroviral
Therapy
MSA
Metropolitan
Statistical Area
NRR
No Reported Risk
COPHI
Cases of Public
Health
Importance
5
HIV/STD Service
Oklahoma State
Department of Health
Surveillance: In a public health context, refers to the intentional collection of data on
diseases or other important health conditions in order to monitor where the condition
occurs and to determine the risk factors associated with the condition.
Trend: A long‐term movement or change in frequency, usually upward or downward; may
be presented as a line graph.
Year of diagnosis: The year in which a diagnosis of HIV infection or AIDS was made.
Year of report: The year in which a person with a diagnosis of HIV infection or AIDS was
reported to the health department.
6
7
What are the demographic characteristics
of the general population in Oklahoma?
8
1Population Statistics compiled using the United States Census 2009 American Community Survey 1‐Year Estimates.
Population Statistics1
As of 2009, it was estimated that Oklahoma had a total population of approximately 3.7
million, with 51% (1.9 million) females and 49% (1.8 million) males. Although Oklahoma is
made up of 77 counties, 44% of the population lives in 4 counties: Oklahoma (716,704),
Tulsa (601,961), Cleveland (221,589), and Comanche (113,228). Oklahoma and Tulsa
counties account for 36% of the total population. Oklahoma City (560,226) and Tulsa
(389,369) are the 2 largest cities in the state, followed by Norman (109,056) and Broken
Arrow (101,443).
Race Information
 The majority of Oklahomans reported their race as White (75.4%), followed by
Black/African Americans (7.3%), American Indians and Alaska Natives (6.1%), and
Asians and Hawaiian/Pacific Islanders (less than 2%).
 Seven percent of Oklahomans reported two or more races.
 Seventy‐one percent of Oklahomans were reported as White, Non‐Hispanic.
 Hispanic Oklahomans constituted 8.2% of the population; however, people of Hispanic
origin may be of any race.
Age Information
 The median age in Oklahoma was 35.7 years. More than half (51%) of Oklahomans
were between the ages of 20 and 64.
 Twenty‐five percent of the population was under 18 years and 13 percent was 65 years
and older.
Oklahoma is
ranked 28th for
the largest
population in the
United States.
There are 98
men for every
100 women in
Oklahoma.
Mexican
accounts for
83% of Hispanic
ethnicity in
Oklahoma.
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
White Black American
Indian
Asian/Pacific
Islander
Other Multiple
Race
Number of People
Race Group
Chart 1. Race Distribution of People
in Oklahoma for 2009*
*2009 American Community Survey 1‐Year Estimates
9
HIV/STD Service
Oklahoma State
Department of Health
 Of the Oklahomans age 18 years and older, 49% were male and 51% were female. Of those 65
years and older, 43% were male and 57% were female.
 Age group 15‐24 years constituted 14.7% of the Oklahoma population.
Income Information
 In 2009, there were 1.4 million households in Oklahoma. The average household size was 2.5
people and the average family size was 3.1 people.
 The median household income in Oklahoma was $41,664 with 15% of Oklahomans below the
federal poverty line and 85% at or above the poverty line.
0
100,000
200,000
300,000
400,000
500,000
600,000
0‐9 10‐14 15‐19 20‐24 25‐34 35‐44 45‐54 55‐64 65+
Number of People
Age Group (in years)
Chart 2. Age Distribution of People
in Oklahoma for 2009*
*2009 American Community Survey 1‐Year Estimates
0
50,000
100,000
150,000
200,000
250,000
300,000
Less than
$15K
$15K to
$24K
$25K to
$34K
$35K to
$49K
$50K to
$74K
$75K to
$99K
$100K to
$149K
$150K to
$199K
$200K or
more
Number of People
Annual Income (in Dollars)
Chart 3. Income Distribution of People in
Oklahoma for 2009*
*2009 American Community Survey 1‐Year Estimates
10
 Sixteen percent of all Oklahomans were living in poverty. Of families with a female
head of household and no husband present, 36% had incomes below the poverty
level.
 Fifty‐nine percent of the Oklahoma population were married (15 years or older),
22% were single or had never married, and 12% were divorced (7% are widowed).
 In 2009, of Oklahomans 16 years and older who were employed, the leading
industries were educational services, health care, and social assistance (combined
for 23%), and retail trade (11%).
Education Information
 Eighty‐six percent of Oklahomans age 25 years and older had at least a high school
diploma, while 23% had a bachelor's degree or higher.
 Fourteen percent of adults in Oklahoma were classified as dropouts, which is
defined as not being enrolled in school and having not graduated from high school.
 In 2009, the Oklahoma school enrollment was 968,000. Nursery school and
kindergarten enrollment was 120,000 and elementary through high school
enrollment was 596,000. College through graduate school enrollment was
252,000.
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
9th to 12th
grade, no
diploma
High school
graduate
Some college,
no degree
Associate's
degree
Bachelor's
degree
Graduate or
professional
degree
Number of People
Educational Attainment
Chart 4. Education Distribution of People in
Oklahoma for 2009
*2009 American Community Survey 1‐Year Estimates
3.1% of
Oklahomans
live in a
multigenerational
household.
39% of
Oklahomans have
two vehicles per
household.
19% of
Oklahomans have
no health
insurance (public
or private).
11
12
13
What is the scope of HIV/AIDS
in Oklahoma?
14
Overview
At the end of 2009, an estimated 8,181 cases of HIV/AIDS had been diagnosed
among residents of Oklahoma. A breakdown of these HIV/AIDS cases shows 5,335
AIDS cases and 2,846 HIV cases. An estimated 4,924 cases of HIV/AIDS were living
with the infection; 2,441 (49.6%) AIDS cases and 2,483 HIV cases (50.4%). By 2009,
3,257 cases were known to have died.
By Age Group
Of the total HIV/AIDS cases diagnosed in Oklahoma by age group (age at diagnosis):
 30‐39 year olds accounted for 39% (3,151),
 20‐29 year olds accounted for 31% (2,563),
 40‐49 year olds accounted for 18% (1,512),
 50‐59 year olds accounted for 6% (494),
 Teenagers (13‐19 years) represented 3% (217),
 Age 60 years and above accounted for 2% (163),
 Pediatric cases (12 and under) accounted for 1% (64), and
 17 of the cases did not have an age of diagnosis reported.
In 1982, the first
2 cases of AIDS
were diagnosed
in Oklahoma.
The ratio of
males to females
diagnosed with
HIV/AIDS was
6:1.
74% of
Oklahoma men
diagnosed with
HIV had a risk
factor of MSM or
MSM & IDU.
Unknown
13<
13‐19
20‐29
30‐39
40‐49
50‐59
60+
0 1000 2000 3000 4000
Age at Diagnosis
Number of Cases
Chart 6. Cumulative HIV/AIDS in Oklahoma
as of 2009
0
1000
2000
3000
4000
5000
6000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of cases
Year of Diagnosis
Chart 5. HIV and AIDS Cases Diagnosed in Oklahoma
by Year, Incidence vs. Prevalence for 1999 ‐2009
Incidence Prevalence
15
HIV/STD Service
Oklahoma State
Department of Health
By Gender
Since 2000, males in Oklahoma have seen a 5% increase in the number of cases
diagnosed (from 243 cases to 255), while Oklahoma females have seen an 18%
decrease (from 67 cases to 57).
Among males, Hispanic males had the largest percent increase (108%) from 2000 to
2009 (13 cases to 27 cases).
 Black males had the second largest percent increase in Oklahoma (41%),
from 49 cases to 69 cases.
 American Indian and Alaska Native males had the largest percent decrease
(75%) among all races (21 cases to 12 cases), and
 White males had the second largest percent decrease (13%), from 158 cases
to 140 cases.
 Asian/Pacific Islanders and those with two or more races stayed about the
same from 2000 to 2009.
Among females diagnosed with HIV/AIDS in Oklahoma:
 Black females had a 20% increase in cases between 2000 and 2009 (from 20
cases to 24 cases).
 Hispanic females also had an increase in cases; however, only accounted for
4 cases diagnosed in 2009.
 White females experienced a 50% decrease in cases over the past decade.
 American Indians and Alaska Natives also experienced a decrease (33%) from
8 cases to 6 cases; however, only accounted for 11% of cases in 2009.
 Overall, the number of female cases has been irregular over the past 10
years.
0
50
100
150
200
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 7. New HIV/AIDS Cases Among Males by Race,
Oklahoma 2000‐2009
White
Black
Hispanic
AI/AN
Asian/PI
Multi
16
Since 2000,
HIV/AIDS
diagnoses among
Oklahomans
50‐59 years old
has increased
39%.
HIV Cases among
Hispanics/Latinos
have doubled
over the past
10 years.
Most of the
HIV/AIDS
deaths in 2009
were among
Blacks.
By Race and Ethnicity
Of the cumulative HIV/AIDS cases diagnosed in Oklahoma,
 5,320 (65%) were White,
 1,703 (20.8%) were Black/African American,
 469 (5.7%) were Hispanic,
 42 (0.5%) were Asian/Hawaiian Pacific Islanders, and
 522 (6.4%) were American Indian/Alaskan Native.
 Persons who reported multiple races accounted for 125
(1.5%) of the cases diagnosed.
By Mode of Transmission
Of the cumulative HIV/AIDS cases among children, adolescents, and adults:
 53% (4,311) were classified as men who have sex with men (MSM);
 11% (931) were classified as injection drug use (IDU);
 11% (857) were classified as MSM & IDU;
 10% (804) were classified as heterosexual sex with someone HIV positive;
 2% (136) received blood or blood products;
 Less than 1% were perinatal exposures;
 Less than 0.5% were classified as other confirmed risk; and
 33% (103) were classified as NRR or NIR.
��� 62% of males had a risk of MSM, while 43% of females had a risk or
heterosexual.
Table 4. Cumulative HIV/AIDS Cases Diagnosed in Oklahoma
By Race/Ethnicity and Sex as of 2009
Race/Ethnicity Male Female Total
White 4,680 640 5,320
Black 1,359 344 1,703
Hispanic, All Races 394 75 469
Asian/Pacific Islander 32 10 42
American Indian/Alaska Native 422 100 522
Multiple Races 94 31 125
17
HIV/STD Service
Oklahoma State
Department of Health
HIV/AIDS Deaths
Since 1982, a total of 3,257 Oklahomans diagnosed with HIV/AIDS have died.
 Males accounted for 89% of deaths, and females accounted for 11%.
 Age group1 30‐39 years accounted for 40% of deaths, followed by 20‐29
years (29%), and 40‐49 years (19%).
 72% of deaths were among Whites, followed by Blacks (17%), and American
Indians and Alaska Natives (7%).
Of those Oklahomans who died in 2009:
 All were male.
 The majority were Black (70%), with the remainder being White (30%).
 Most (80%) were ages 40‐59 years.
�� Half (50%) were classified as MSM, 40% were classified as either NRR or NIR,
and 10% were heterosexual contact.
0
1000
2000
3000
4000
5000
Number of Cases
Mode of Transmission
Chart 8. New HIV/AIDS Cases Among Males
by Mode of Transmission, Oklahoma 2009
1Age group based on age at diagnosis.
18
Overview
At the end of 2009, an estimated 4,924 cases of HIV/AIDS had been diagnosed
among residents of Oklahoma with a prevalence rate of 134 per 100,000 population.
Since 2000, there has been a 35% increase in the number of living (prevalent) HIV
cases. Of the 312 HIV/AIDS cases diagnosed in Oklahoma in 2009, 302 were still
living by the end of 2009.
By Age Group
The age group breakdown of living HIV/AIDS cases diagnosed in Oklahoma was
similar to the breakdown of cumulative cases (age at diagnosis):
 30‐39 year olds accounted for 37.7% (1,860),
 20‐29 year olds accounted for 33% (1,620),
 40‐49 year olds accounted for 18.3% (900),
 50‐59 year olds accounted for 5.5% (271),
 Teenagers (13‐19 years) represented 3.6% (175),
 Age 60 years and above and Pediatric cases (12 and under)
accounted for less than 2% (87), and
 11 of the cases did not have an age of diagnosis reported.
Since 2000, most age groups have seen an increase in the number of living HIV/AIDS
cases diagnosed each year.
 There has been a 100% increase in the number of living HIV/AIDS cases
diagnosed among persons 13‐19 years (from 9 cases to 18 cases).
 Persons 20‐29 years of age had a 75% increase over the past ten years, from
59 cases to 103 cases.
2,441 living
AIDS cases and
2,483 living HIV
cases were
diagnosed in
Oklahoma as of
2009.
There are 5 men
for every woman
living in
Oklahoma with
HIV.
20‐39 year olds
account for 70%
of cases.
0
1000
2000
3000
4000
5000
6000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 9. Living HIV and AIDS Cases Diagnosed in
Oklahoma by Year,
New Cases vs. Total Living for 2000‐2009
New Total
19
HIV/STD Service
Oklahoma State
Department of Health
By Gender
As of 2009, males diagnosed in Oklahoma accounted for 83% of living HIV/AIDS cases
at a rate of 224 per 100,000 population. In comparison, females accounted for 17%
of cases at a rate of 45 per 100,000. In 2000, the prevalence rate for males was
113.5 per 100,000 population and for females it was 20 per 100,000 population.
Among females diagnosed in Oklahoma and living with HIV/AIDS:
 Black females had a 100% increase in cases between 2000 and 2009 (from 12
cases to 24 cases).
 Hispanic females also had an increase in cases; however, only accounted for
4 cases diagnosed in 2009.
 All other races stayed about the same.
Unknown <13 13‐19 20‐29 30‐39 40‐49 50‐59 60+
0
500
1000
1500
2000
Age at Diagnosis
Number of Cases
Chart 10. HIV/AIDS Prevalence in Oklahoma
by Age Group as of 2009
0
100
200
300
400
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 11. HIV/AIDS Prevalence in Oklahoma
by Gender, 2009
Male Female
20
The prevalence
rate among
Blacks is 4
times higher
than Whites.
Since 2000,
cases among
Hispanics
increased 139%.
Since 2000,
heterosexual
cases have
increased 44%.
Among males, except for American Indian and Alaska Native males, all races saw
some type of increase from 2000 to 2009.
 Hispanic males had the largest percent increase (125% increase) from 2000
to 2009 (12 cases to 27 cases).
 Black males had the second largest percent increase in Oklahoma (77%),
from 35 cases to 62 cases.
 White males had the third largest percent increase (17%), from 117 cases to
137 cases.
 American Indian and Alaska Native males had the largest percent decrease
(25%) among all races (16 cases to 12 cases).
By Race and Ethnicity
Of persons living with HIV/AIDS and diagnosed in Oklahoma at the end of 2009,
 Whites had a rate of 107 per 100,000 population.
 Blacks had a rate of 428 per 100,000 population, more than three times
higher than the state rate. Since 2000, Blacks have had an 83% increase in
the number of cases.
 Hispanics had a rate of 119 per 100,000 population.
 Asian/Pacific Islanders had a rate of 52 per 100,000 population.
 American Indian/Alaskan Natives had a prevalence rate of 138 per 100,000
population.
 19 per 100,000 population was the prevalence rate for persons who
reported multiple races.
Table 5. Living HIV/AIDS Cases Diagnosed in Oklahoma
By Race/Ethnicity as of 2009
Race/Ethnicity AIDS HIV Total
White 1,476 1,497 2,973
Black 534 616 1,150
Hispanic, All Races 186 172 358
Asian/Pacific Islander 16 17 33
American Indian/Alaska Native 177 131 308
Multiple Races 52 50 102
21
HIV/STD Service
Oklahoma State
Department of Health
By Mode of Transmission
Of the living HIV/AIDS cases among children, adolescents, and adults:
 50% (2,470) were classified as men who have sex with men (MSM);
 11% (525) were classified as injection drug use (IDU);
 9% (455) were classified as MSM & IDU;
 12% (579) were classified as heterosexual sex with someone HIV positive;
 Less than 1% (41) received blood or blood products;
 Less than 1% (29) were perinatal exposures; and
 17% (825) were classified as NRR or NIR.
Geographic Distribution in Oklahoma
 Five counties in Oklahoma accounted for 76% of the living HIV (Not AIDS) cases
diagnosed in Oklahoma: Oklahoma (955), Tulsa (637), Cleveland (160),
Comanche (143), and Canadian (47).
 The top five counties with the highest prevalence of HIV (Not AIDS) cases are as
follows:
1. Oklahoma County ‐ 135 per 100,000 population
2. Comanche County ‐ 127 per 100,000 population
3. Tulsa County ‐ 108 per 100,000 population
4. Caddo County ‐ 89 per 100,000 population
5. Blaine County ‐ 79 per 100,000 population
MSM
IDU 61%
8%
MSM/IDU
11%
Hetero
5%
Perinatal
0%
Blood Products
1%
Unknown
14%
Chart 12. HIV/AIDS Prevalence Among Males
by Mode of Transmission, Oklahoma 2009
1Age group based on age at diagnosis. 22
Overview
In 2009, 312 cases of HIV/AIDS were diagnosed in Oklahoma. This was a 9% decrease in
the number of cases diagnosed in 2008. From 1999 to 2009 (11 years), 3,614 cases of
HIV/AIDS were diagnosed at an average of 329 cases per year, with an average rate of 9.1
cases per 100,000 population per year. Although there was approximately a 26% decrease
in the number of newly diagnosed AIDS cases between 1999 and 2009, there was a 49%
increase in the number of newly diagnosed HIV cases.
Of the 312 cases diagnosed,
 255 cases were among males (with a rate of 14 per 100,000 population); and
 57 cases were among females (with a rate of 3.1 per 100,000 population).
During 2009, three counties in Oklahoma accounted for about 61% of the cases:
 Oklahoma 32.7% (102),
 Tulsa 21.8% (68), and
 Cleveland 6.4% (20).
By Age Group
Of the total HIV/AIDS cases diagnosed in 2009 by age group:
 20‐29 year accounted for 33% (104),
 30‐39 years accounted for 30% (92),
 40‐49 years accounted for 20% (62),
 50‐59 year accounted for 10% (32),
 Teenagers (13‐19 years) represented 6% (18), and
 Age 60 years and above accounted for 1% (4).
0
50
100
150
200
250
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 13. HIV and AIDS Cases Diagnosed in
Oklahoma by Year, 1999‐2009
HIV cases AIDS cases
Oklahoma is
ranked 29th for
the largest
number of new
diagnoses of HIV.
In 2009, there
were 180 HIV
and 132 AIDS
cases diagnosed
in Oklahoma.
Oklahoma had a
total of 312 new
HIV/AIDS cases in
2009, and 342 in
2008.
23
HIV/STD Service
Oklahoma State
Department of Health
13‐19
6%
20‐29
33%
30‐39
30%
40‐49
20%
50‐59
10%
60+
1%
Chart 14. New Diagnoses of HIV/AIDS in
Oklahoma, 2009
By Race and Ethnicity
 Among racial and ethnic groups, Blacks/African Americans (31.3 cases per 100,000
population) had the highest rate of new HIV/AIDS cases for 2009. Their rate was
almost four times the rate for the entire state.
 Hispanics (10.3 cases per 100,000 population) had the second highest rate for new
HIV/AIDS cases in Oklahoma for 2009. The rate for Hispanics was 1.2 times higher than
the state rate.
 Asian/Pacific Islanders had a rate of 7.5 per 100,000 population,
 American Indians /Alaskan Natives had a rate of 6.1 cases per 100,000 population, and
 Whites had a rate of 5.6 cases per 100,000 population.
24
Since 2000, the
number of cases
among teens
has almost
doubled.
Since 2000, there
has been as
135% increase
among ages 20‐
29 years.
The rate of new
HIV/AIDS cases
among black
males is 47 per
100,000
population.
By Mode of Transmission
Of the 312 cases who reported their risk,
 43.6% (136) were classified as men who have sex with men (MSM),
 14.1% (44) were classified as heterosexual sex with someone HIV positive,
 5.8% (18) were classified as injection drug use (IDU),
 3.5% (11) were classified as MSM and IDU, and
 33% (103) were classified as no reported risk or no identified risk.
0 25 50 75 100 125 150
MSM
IDU
MSM/IDU
Hetero
Unknown
Number of Cases
Mode of Transmission
Chart 16. New HIV/AIDS Cases by Mode of
Transmission and Gender, Oklahoma 2009
Female Male
0
20
40
60
80
100
120
140
160
White Black Hispanic Asian/Pacific
Islander
AI/AN Multi‐Race
Number of Cases
Race/Ethnicity
Chart 15. New HIV/AIDS Cases by Race and Gender,
Oklahoma 2009
Male
Female
25
HIV/STD Service
Oklahoma State
Department of Health
Geographic Distribution
Of those newly diagnosed in 2009, the top five zip codes in the Oklahoma City and Tulsa
areas are as follows (in order of largest number of cases):
1. 73107
2. 73112
3. 73106 and 73105
4. 74105 and 73118
5. 74137 and 73109
Table 6. Top Five Counties of Newly Diagnosed HIV/AIDS Cases
in Oklahoma for 2009
By Number of Cases By Rate per 100,000
1 Oklahoma Osage
2 Tulsa Hughes
3 Cleveland Logan
4 Osage Oklahoma
5 Canadian Tulsa
*Counties with fewer than 3 cases were removed from the analysis for confidentiality reasons.
26
27
What are the indicators of risk for HIV
infection and AIDS in Oklahoma?
28
MSM AIDS cases
have decreased
69% since 2000.
HIV cases among
MSM and MSM &
IDU have
increased 42%.
73% of all males
diagnosed in
Oklahoma had an
exposure of MSM
or MSM & IDU.
Overview
Of the 4,924 persons living with HIV/AIDS at the end of 2009, more than half (60%)
reported a mode of transmission of MSM or MSM & IDU. Of all the males living with
HIV/AIDS, 72% reported their risk as MSM or MSM & IDU, and 61% reported a risk of MSM
only. Since 1982, a total 5,168 HIV/AIDS cases have reported a risk of MSM or MSM & IDU.
Of new HIV cases (180) diagnosed in Oklahoma in 2009, MSM accounted for 76% of cases,
while MSM & IDU accounted for 6%. Although MSM transmission has decreased 55%
among new AIDS cases since 2000, it has increased 54% among new HIV cases.
 Of the 8,181 cumulative cases diagnosed in Oklahoma (regardless of transmission), 63%
were among males who identified themselves as MSM or MSM & IDU.
 In 2009, 47% of all cases diagnosed in Oklahoma were among MSM or MSM & IDU.
 Of the 2,925 MSM and MSM & IDU living with HIV/AIDS at the end of 2009, 84% were
MSM and 16% were MSM & IDU.
By Age Group
 Of the cumulative cases diagnosed in Oklahoma, 30‐39 years comprised the largest
proportion (41%), followed by 20‐29 years (34%) and 40‐49 years (17%).
 In 2009, 38% of HIV/AIDS cases were diagnosed among age group 20‐29 years, followed
by 30‐39 years (27%), and 40‐49 years (17%).
0
50
100
150
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 17. HIV/AIDS Cases by Diagnosis Year for Men
Who Have Sex with Men*, Oklahoma 2000‐2009
AIDS
HIV
* Includes MSM and MSM & IDU
29
HIV/STD Service
Oklahoma State
Department of Health
 Of gay and bisexual males living with HIV/AIDS as of December 2009, 42% had a current
age of 40‐49 years, followed by 24% who were age 50‐59 years, and 20% being 30‐39
years of age.
 Since 2000, there has been an 80% increase in HIV cases among ages 20‐24 years and a
38% increase among those 25‐29 years.
 Age group 30‐39 years has had a decrease in both HIV (33% decrease) and AIDS (63%
decrease) over the past 10 years.
 Age group 50‐59 years has had a 100% increase in HIV cases with 4 cases in 2000 and 8
cases in 2009.
By Race/Ethnicity
 Of all cases diagnosed in Oklahoma, Black males accounted for 17% of gay and bi‐sexual
males diagnosed with HIV/AIDS. Black males account for 3.6% of Oklahomans.
 American Indian/Alaska Native males comprised 6% of cases diagnosed in Oklahoma,
however, account for only 2.9% of the population.
 In 2009, Black males represented 17% of MSM and MSM & IDU cases, followed by
American Indian and Alaska Native males (6%), and Hispanic males (4%).
 Over the past 10 years, White males had a 47% decrease in the number of AIDS cases
and a 58% increase in the number of HIV cases.
0
10
20
30
40
50
60
70
80
90
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 18. HIV/AIDS Cases Among Men Who Have
Sex with Men by Age Group, Oklahoma 2000‐2009
13 ‐ 19 yrs
20 ‐ 24 yrs
25 ‐ 29 yrs
30 ‐ 39 yrs
40 ‐ 49 yrs
50 ‐ 59 yrs
60 and
over
* Includes MSM and MSM & IDU
30
Since 2000, there
has been a
150% increase
of HIV cases
among those age
13‐19 years.
In 2009, White
males accounted
for 71% of MSM
cases and
comprised only
37% of the
Oklahoma
population.
 Of gay and bisexual males living with HIV/AIDS in Oklahoma at the end of 2009,
o 67% were White,
o 19% were Black,
o 6% were American Indian or Alaska Native,
o 5.5% were Hispanic, and
o 2% had Multiple Races.
 Since 2009, Black males have had a 26% decrease in AIDS cases and a 20% increase in
HIV cases.
 Hispanic males have had a 66% increase in AIDS cases since 2000, and a 33% increase in
HIV cases.
 American Indian and Alaska Native males have experienced a 266% decrease in the
number of AIDS cases (from 11 cases to 3 cases), however a 33% increase among HIV.
By Geographic Distribution
 Of the new MSM cases diagnosed in 2009,the top five counties with the largest number
of cases were as follows:
1. Oklahoma
2. Tulsa
3. Osage
4. Cleveland and Canadian
5. Creek and Logan
 The top three zip codes with the largest number of new MSM diagnoses in the
Oklahoma City and Tulsa areas were as follows: 73112, 74105, and 73106.
0
20
40
60
80
100
120
140
White Black Hispanic AI/AN Multi
Number of Cases
Race/Ethnicity
Chart 19. HIV/AIDS Cases Among Men Who Have Sex
With Men by Race/Ethnicity, Oklahoma 2000‐2009
2009
2004
2000
* Includes MSM and MSM & IDU
31
32
Overview
By the end of 2009, 1,788 Oklahomans diagnosed with HIV/AIDS reported a risk of
either IDU or MSM & IDU. A total of 931 were classified as IDU only. Of the 4,924
Oklahomans living with HIV/AIDS, 11% (525) were classified as IDU, and 9% (455)
were classified as MSM & IDU.
Of new HIV/AIDS cases (312) diagnosed in Oklahoma in 2009, IDU accounted for 6%
of cases, while MSM & IDU accounted for 4% (a combined total of 9.3%). IDU
transmission has decreased drastically over the past decade. In 2000, IDU and MSM
& IDU accounted for 18% of new HIV/AIDS cases and 24% of total cases diagnosed in
Oklahoma.
By Age Group
The age group breakdown of IDU and MSM & IDU HIV/AIDS cases diagnosed in
Oklahoma are as follows:
 30‐39 year olds accounted for 43% (768),
 20‐29 year olds accounted for 32% (570),
 40‐49 year olds accounted for 18% (329),
 50‐59 year olds accounted for 4% (66),
 Teenagers (13‐19 years) represented 2% (39),
 Age 60 years and above accounted for less than 1% (13), and
 3 of the cases did not have an age of diagnosis reported.
22% of all
HIV/AIDS cases
diagnosed in
Oklahoma
are IDU.
Of the 29 new
IDU cases
diagnosed in
2009, 62% were
IDU only.
38% of newly
diagnosed IDU
cases in 2009
were
MSM and IDU.
0
10
20
30
40
50
60
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 20. HIV/AIDS Cases by Diagnosis Year for
Injection Drug Users*, Oklahoma 2000‐2009
IDU
MSM
&IDU
* Includes IDU and MSM & IDU
33
HIV/STD Service
Oklahoma State
Department of Health
Since 2000, there has been a 66% decrease of HIV/AIDS cases among newly
diagnosed persons classified as IDU or MSM &IDU.
 Among IDU only, there has been a 68% decrease of newly diagnosed
HIV/AIDS cases in Oklahoma since 2000.
 Among MSM & IDU, there has been a 61% decrease of newly diagnosed
HIV/AIDS cases since 2000.
By Gender
 Of new cases diagnosed in 2009, males accounted for 76% of cases, while
females accounted for 24% of cases.
 In 2000, males accounted for 71% of IDU cases and females accounted for
29% of cases.
Unknown <13 13‐19 20‐29 30‐39 40‐49 50‐59 60+
0
100
200
300
400
500
600
700
800
900
Age at Diagnosis
Number of Cases
Chart 21. Cumulative HIV/AIDS Cases Among IDU*
By Age Group, Oklahoma 2009
*Includes IDU and MSM & IDU
34
By Race and Ethnicity
Of those diagnosed in 2009 (29), and classified as IDU or MSM & IDU:
 Whites accounted for 69%,
 Blacks accounted for 17% ,
 Hispanics accounted for 7%, and
 American Indian and Alaska Natives accounted for 7%.
 All other races did not have any IDU cases.
Of the 1,788 IDU cases diagnosed in Oklahoma since 1982:
 Whites accounted for 68% (1,218),
 Blacks accounted for 16% (292),
 American Indians and Alaska Natives accounted for 9% (162),
 Hispanics accounted for 5% (87)
 And all other races accounted for less than 2% combined.
0
20
40
60
80
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 22. HIV/AIDS Cases Among Injection Drug
Users* by Year and Gender, Oklahoma 2009
*Includes IDU and MSM & IDU Male Female
Of cumulative
IDU cases, males
accounted for
82%.
In 2009, zip codes
73118 and
73107 had the
largest
percentage of
IDU cases.
35
HIV/STD Service
Oklahoma State
Department of Health
Geographic Distribution in Oklahoma
 Five counties in Oklahoma accounted for 70% of the cumulative HIV/AIDS cases
diagnosed in Oklahoma: Oklahoma (614), Tulsa (413), Cleveland (122),
Comanche (50), and Canadian Counties (35).
 The top five zip codes for IDU cases living with HIV/AIDS in the Oklahoma City
and Tulsa areas were as follows:
1. 73112
2. 73106
3. 73118
4. 74112
5. 74110
White
69%
Black
17%
Hispanic
7%
AI/AN
7%
Chart 23. New HIV/AIDS Cases Diagnosed Among
Injection Drug Users*, Oklahoma 2009
*Includes IDU and MSM & IDU
36
Overview
Since 1982, there have been 1,169 cases of HIV/AIDS diagnosed in Oklahoma
females. Of those cases, 655 (56%) were AIDS cases and 514 (44%) were HIV cases.
At the end of 2009, 71% (828) of the female cases were still living. In 2009, 57 cases
of HIV/AIDS were diagnosed among females at a rate of 3 per 100,000 population,
which was an 18% decrease in cases since 2000. Although there was an overall
decrease in female HIV/AIDS cases, there was a 39% increase in HIV only cases in
females.
By Age Group
The age group breakdown of cumulative HIV/AIDS cases diagnosed in Oklahoma
females are as follows:
 20‐29 year olds accounted for 35% (404),
 30‐39 year olds accounted for 34% (394),
 40‐49 year olds accounted for 19% (216),
 Teenagers (13‐19 years) represented 6% (69),
 50‐59 year olds accounted for 5% (59), and
 Age 60 years and above accounted for less than 3% (27).
Since 2000, age group 13‐19 years had a large increase in cases, however, only
accounted for 14% (8) of total cases diagnosed among females in 2009.
There has been a
39% increase in
HIV only cases in
females
since 2000.
Since 2000,
HIV/AIDS cases in
Oklahoma
females 13‐19
years old have
increased
100%.
Black females
have had a 26%
increase in cases
since 2000.
0
10
20
30
40
50
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 24. HIV/AIDS Cases by Diagnosis Year for
Females*, Oklahoma 2000‐2009
AIDS
HIV
* Females Age 13 and Above
37
HIV/STD Service
Oklahoma State
Department of Health
By Race and Ethnicity
Of those females newly diagnosed with HIV/AIDS in 2009 (57):
 39% were White,
 42% were Black,
 11% were American Indian or Alaska Native,
 7% were Hispanic, and
 Less than 2% were Asian or Pacific Islander.
Of the 1,169 female cases diagnosed in Oklahoma since 1982:
 Whites accounted for 53% (620),
 Blacks accounted for 29% (340),
 American Indians and Alaska Natives accounted for 8% (97),
 Hispanics accounted for 6% (73),
 Two or more races accounted for 3% (30), and
 Asian/Pacific Islander accounted for less than 1% combined (9).
13‐19 20‐29 30‐39 40���49 50‐59 60+
0
100
200
300
400
500
Age at Diagnosis
Number of Cases
Chart 25. Cumulative HIV/AIDS Cases Among
Females* By Age Group, Oklahoma 2009
*Females age 13 and above AIDS HIV
38
By Mode of Transmission
Since 1982, cumulative HIV/AIDS cases diagnosed in females were classified as
follows:
 Heterosexual (46%),
 IDU (27%),
 Unknown (23%),
 Blood or blood products (2%), and
 Other (less than 1%).
Of newly diagnosed HIV/AIDS cases in 2009:
 12% were classified as IDU,
 39% were classified as heterosexual contact, and
 49% were unknown (NRR or NIR).
Geographic Distribution in Oklahoma
 Six counties in Oklahoma accounted for 75% of the newly diagnosed female
HIV/AIDS cases in Oklahoma: Oklahoma (16), Tulsa (11), Osage (6), Cleveland (4),
Rogers (3), and Payne (3).
 The top four zip codes for female cases living with HIV/AIDS in the Oklahoma City
and Tulsa areas were as follows:
1. 73111
2. 74106
3. 73106
4. 74136
White
39%
Black
42%
Hispanic
7% AI/AN
10%
Asian/PI
2%
Chart 26. New HIV/AIDS Cases Diagnosed Among
Females by Race/Ethnicity,* Oklahoma 2009
*Females age 13 and above
Black women
have a rate 8
times higher than
white women.
Since 2000, the
number of IDU
cases among
females has
decreased 71%.
AI/AN and
Hispanic women
have a rate 2
times higher than
white women.
39
40
41
What are the patterns of service utilization
of HIV infected persons in Oklahoma?
42
Overview
The Ryan White Treatment and Modernization Act provides funding for HIV care for the
majority of HIV infected clients in the United States. Ryan White (RW) is the payer of last
resort and, consequently, serves indigent clients with no other means of obtaining medical
care or psychosocial support. A disproportionate number of individuals who receive Ryan
White care and treatment services are on the margins of society and include minorities,
women, and individuals with substance abuse and mental illness. Funding of Ryan White
programs is categorized by Parts A‐F, each of which provides funding for specific purposes.
The OSDH HIV Treatment and Care Division is currently receiving Part B funding. There is
no Part A funding in Oklahoma because it is considered a low incidence State. There are
two Part C Early Intervention Services (EIS) clinics in Oklahoma:
 University of Oklahoma (OU) Health Sciences Center Infectious Disease Clinic in
Oklahoma City, and
 Oklahoma State University (OSU) Internal Medicine Special Services in Tulsa.
In Oklahoma, there is one Part D program, also located at the University of Oklahoma
Health Sciences Center in Oklahoma City.
The Ryan White Program at the Oklahoma State Department of Health provides a vast array
of services to HIV positive clients who meet income and eligibility guidelines. These services
include primary specialty care, oral healthcare, mental health treatment, HIV medication
assistance, health insurance assistance, medical transportation services, medical and non‐medical
case management, and outpatient substance abuse treatment.
Oklahoma is funded by Part B of the Ryan White Treatment and Modernization Act. A large
portion of Part B funding in Oklahoma is directed toward life‐sustaining HIV medications
through the AIDS Drug Assistance Program, or the Oklahoma HIV Drug Assistance Program
(HDAP) and Health Insurance Assistance Program (HIAP).
HIV Drug Assistance Program (HDAP)
HDAP is a statewide prescription assistance program administered through the Oklahoma
State Department of Health by a contract with the drug wholesaler, Cardinal, and the
dispensing pharmacy, OU Pharmacy Care Center, which provides specific HIV related
medications to eligible low‐income individuals living with HIV disease in Oklahoma. The
HDAP drug formulary has increased from 47 drugs in 2003 to 156 currently in 2010,
including all FDA approved HIV antiretroviral therapies. Funding for HDAP comes primarily
from the federal Ryan White CARE Act Part B grant to the state.
RW Part A
Provides funding
to metropolitan
areas most
affected by the
HIV epidemic
RW Part B
Provides funding
to state health
departments for
HIV care
RW Part C
Funds individual
medical facilities
that care for HIV
infected clients
RW Part D
Funds services
for women and
children
43
HIV/STD Service
Oklahoma State
Department of Health
HIV Insurance Assistance Program (HIAP)
The HIV Insurance Assistance Program is a statewide program providing assistance with
continuation of health insurance premium payments for those eligible low‐income
individuals living with HIV disease in Oklahoma who have health insurance plans that
qualify for the program. This program was first implemented in October of 2001 and
continues to increase in utilization. Nearly doubling clients served in 2006, 311 individuals
received insurance assistance in 2009.
There has been a consistent increase in the number of individuals served through the
HDAP, co‐pay assistance, and health insurance assistance program each year. Since 2000,
there has been a 111% increase in the total HDAP assistance (HDAP only, co‐pay, and
health insurance) per month to 1,398 clients served per month in fiscal year (FY) 2009.
0
200
400
600
800
1000
1200
1400
1600
1996 2000 2006 2007 2008 2009
Number of Clients
Fiscal Year
Chart 27. Total Clients Served in Oklahoma
by Fiscal Year and Program
Insurance Assistance Co‐Pay Assistance Total HDAP
44
By continuing insurance premiums and assisting clients with co‐pays, the program saves
money. The average cost per client on insurance assistance was $233 per month versus
$959 per month for a client who does not have insurance and obtains prescriptions through
the drug assistance program alone. The ODSH requires clients eligible for Medicare D
prescription assistance, O‐EPIC (Insure Oklahoma) and other forms of insurance to enroll in
these plans to reduce costs per client. This also benefits the client by providing access to
insurance for medical appointments in addition to prescription access.
RW Part F
Funds AIDS
Education and
Training Centers
(AETC), Dental
Reimbursement,
and Special
Projects of
National
Significance
(SPNS)
Oklahoma
received
$3,618,532
for RW Part B
Funding for 2009
In 2009, the
OSDH was
funded
$4,268,335
for ADAP
0
200
400
600
800
1000
1996 2000 2006 2007 2008 2009
Clients Served
Fiscal Year
Chart 28. Average Clients Served in Oklahoma Per
Month by Fiscal Year and Program
Insurance Assistance Co‐Pay Assistance HDAP
0
500
1000
1500
1996 2000 2006 2007 2008 2009
Number of Clients
Fiscal Year
Chart 29. Average Cost Per Client by Fiscal Year
and Program, Oklahoma
Insurance Assistance Co‐Pay Assistance HDAP
45
HIV/STD Service
Oklahoma State
Department of Health
More importantly, by continuing insurance for clients and paying for prescriptions, the
HDAP program is able to improve health outcomes as well. In 2004, only 50% of clients had
undetectable viral loads that were enrolled in some form of assistance, but in 2009 63%
had undetectable viral loads. The longer a client has been on ART, the more the viral load
decreases and overall health improves. In 2009, 89% of HDAP clients who were on ART for
3 years or more had undetectable viral loads as compared to only 53% who had been on
ART for 1 year or less.
53%
78%
89%
0%
20%
40%
60%
80%
100%
<=1 1 to 2 3 or more
% Undetectable
Years on Regimen
Chart 30. Percent of Clients with Undectable Viral
Loads by Length of Time on ART Regimen, FY09
46
Overview
Included in the HIV/STD Service is the Division of HIV/STD Prevention and Intervention
(DPI). The division receives federal funds for both HIV and STD prevention through Centers
for Disease Control and Prevention (CDC) and has over twenty highly trained and educated
professionals to provide these services. This division is responsible for disease investigation
of newly reported HIV and syphilis, and facilitates all medical referral services for anyone
who has been infected with or exposed to HIV or STDs. This division also provides oversight
of all funded and non‐funded HIV testing sites in Oklahoma, as well as, training and
education in HIV counseling, risk reduction, and STD prevention to community partners and
consumers.
DPI has several health education and training staff who facilitate trainings and educational
opportunities throughout Oklahoma. Some of these trainings include: HIV 101 Seminar;
HIV Counseling, Testing and Referral; STD 101 Seminar; RESPECT; and Bridging Theory and
Practice. The OSDH also supports and coordinates trainings such as Community
Identification, Diffusion of Effective Behavioral Intervention (DEBI) programs, and other
prevention strategies and projects.
Counseling, Testing and Referral Services (CTR)
Currently, DPI contracts with five CBOs to provide HIV CTR services for high risk
Oklahomans. These CTR sites are located in Oklahoma City and Tulsa. DPI also supports 14
sites throughout the state to provide CTR through the donation of laboratory services to
confirm preliminary positive results. The funded CTR sites include: Red Rock Behavioral
Health Services, RAIN Oklahoma, Health Outreach Prevention Education, Inc. (HOPE), and
Guiding Right, Inc. (GRI) Oklahoma City and Tulsa locations.
Health Education and Risk Reduction (HE/RR)1
 Community PROMISE (Peers Reaching Out and Modeling Intervention Strategies) is a
community‐level intervention which the OSDH supports through a contract with HOPE
in Tulsa. This intervention promotes progress toward consistent HIV prevention
practices through community mobilization and distribution of small media materials and
risk reduction supplies, such as condoms.
 CRCS (Comprehensive Risk Counseling and Services) formerly PCM, is an intensive,
individualized client‐centered counseling intervention for adopting and maintaining HIV
risk‐reduction behaviors. CRCS is designed for HIV‐positive and HIV‐negative individuals
who are at high risk for acquiring or transmitting HIV and STDs and struggle with issues
such as substance use and/or abuse, physical and mental health, and social and cultural
factors that affect HIV risk. DPI maintains inter‐agency agreements with the Oklahoma
State University (OSU) Center for Health Sciences Internal Medicine Specialty Services
and the University of Oklahoma (OU) Health Sciences Center Infectious Disease Institute
to provide CRCS.
OSDH HIV
Prevention
Budget awarded
from CDC
$2,440,850
OSDH CTR
Supplemental
Prevention
Budget awarded
$112,085
23,719 HIV
tests were
conducted by
OSDH CTR sites
1 HE/RR descriptions were provided by Centers for Disease Control and Prevention.
47
HIV/STD Service
Oklahoma State
Department of Health
 Many Men, Many Voices (3MV) is a group‐level intervention that addresses behavioral
and social factors influencing the HIV risk behaviors of Black MSM. This multi‐session
intervention uses a menu of behavior change options for HIV prevention. The
intervention addresses factors that influence the behavior of black MSM: cultural, social,
and religious norms; the relationship between HIV and other sexually transmitted
diseases; sexual relationship dynamics; and the social influences that racism and
homophobia have on HIV risk behaviors. 3MV is offered by GRI in Oklahoma City and is
supplemented with additional funding from OSDH DPI.
 Partner, Counseling, and Referral Services (PCRS) is offered to anyone identified as
infected with HIV or syphilis. Eleven Disease Intervention Specialists (DIS) and two Front
Line Supervisors are on staff to provide these services throughout the state. DIS are
responsible for interviewing the infected patients, identifying partners and/or
associates, follow‐up with partners and/or associates for appropriate testing, and
providing referrals for treatment and management of infection.
48
Overview
xPEMS is a web‐based, secure data collection and reporting system specifically for HIV
Counseling , Testing, and Referral services. Oklahoma’s xPEMS database collects the same
data required by the CDC’s Program Evaluation Monitoring System (PEMS). PEMS is a
nation‐wide initiative of the CDC to ensure standardized data collection and evaluation
methods for HIV prevention service provision. All OSDH HIV prevention contractors must
collect and report program planning, budget, and client‐level and aggregate data through
the database.
In Oklahoma, there are currently 90 county health department facilities entering data into
xPEMS along with 5 funded CBO’s and 14 unfunded CBO’s. The newly identified positivity
rates by facilities are as follows: County Health Departments 0.30%, funded CBO’s 1.06%,
and unfunded CBO’s 1.62%. The goal for newly identified positives is a rate of 1.0%.
There were 23,719 tests performed in 2009.
 11,321 were females (rate of 607 per 100,000 population);
 12,385 were males (rate of 680 per 100,000 population).
Of all tests performed, 131 were diagnosed and identified as newly identified positives.
 24 were among females (rate of 1.3 per 100,000 population);
 107 were among males (rate of 5.9 per 100,000 population).
During 2009, two counties in Oklahoma accounted for almost 75% of the newly identified
positives:
 Oklahoma 38.9% (51) and
 Tulsa 35.1% (46).
By Age Group
The age groups for all newly identified positives in 2009 are as follows:
 13‐19 year olds accounted for 7%,
 20‐29 year olds accounted for 37%,
 30‐39 year olds accounted for 29%,
 40‐49 year olds accounted for 18%,
 50‐59 year olds accounted for 8%, and
 Age 60 years and above accounted for 1%.
There are 109
sites in Oklahoma
entering data
into xPEMS.
The Oklahoma
CTR newly
identified
positivity rate for
2009 was
0.55%.
Blacks had a CTR
HIV positivity rate
almost 6 times
higher than
Whites.
49
HIV/STD Service
Oklahoma State
Department of Health
By Race and Ethnicity
 Among racial and ethnic groups, Blacks (26.4 cases per 100,000 population)
had the highest rate of new HIV/AIDS cases for 2009.
 Hispanics had the second highest rate (7 cases per 100,000 population).
 Whites had a rate of 4.5 cases per 100,000 population.
 American Indians/Alaskan Natives had a rate of 4.1 cases
per 100,000 population.
 Asian/Pacific Islanders had a rate of 3.3 cases per 100,000 population.
By Mode of Transmission
 57.3% (75) were classified as men who have sex with men (MSM),
 8.4% (11) were classified as heterosexual sex with someone HIV positive,
 4% (5) were classified as injection drug use (IDU),
 2.3% (3) were classified as MSM & IDU, and
 28% (37) were classified as no reported risk or no identified risk.
Table 7. Top 3 Counties of Newly Identified HIV Counseling, Testing,
and Referral in Oklahoma for 2009
By Number of Cases By Rate per 100,000
1 Oklahoma Roger Mills
2 Tulsa Tulsa
3 Cleveland Oklahoma
50
51
What are the number and characteristics
of Oklahomans who know they are HIV‐positive
but who are not receiving HIV primary care?
52
Overview
Although the Ryan White program serves a large proportion of HIV‐positive low‐income
individuals in Oklahoma, a huge gap still exists for clients who know their HIV status but do
not access primary medical care. States are required to estimate the number of HIV/AIDS
clients that are not receiving primary medical care (unmet need) every 2 years. These
individuals not receiving primary medical care are defined as “out‐of‐care.” States are
encouraged to identify demographic characteristics of the unmet need population.
The Oklahoma unmet need project involved two primary goals:
1. Estimate unmet need using the HRSA definition.
2. Assess the demographic characteristics of those in and out‐of‐care in Oklahoma.
Out‐of‐care (unmet need) was defined as no CD4, viral load, or evidence of ART from
January 1, 2008 through December 31,2008. In care (met need) was defined as having
either a CD4, viral load, or evidence of ART from January 1, 2008 through December 31,
2008. Analysts cross‐matched eHARS with client‐level data sources of care patterns and
death indexes, including: RW CAREWare, Medicaid, HDAP, HIAP, PHIDDO (Public Health
and Disease Detection System of Oklahoma), medical provider chart reviews, and death
certificates.
Unmet Need Facts in Oklahoma
 Forty‐six percent of HIV positive/AIDS clients living in Oklahoma were out‐of‐care in
2008.
 Blacks and Hispanics were more likely to be out‐of‐care than other racial/ethnic
groups.
 Injection Drug Users (IDUs) were more likely to be out‐of‐care than other risk factor
groups.
 Youth were more likely to be out‐of‐care than other age groups.
 The Lawton MSA and Non‐MSA or Rural areas were more likely to be out‐of‐care
than other geographic areas.
 HIV only cases were more likely to be out‐of‐care than AIDS cases.
Table 8. Care Status by Diagnosis
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
Diagnosis
In Care
Number (%)
Out‐of‐care
Number (%)
Total
Number (%)
HIV 1,299 (44%) 1,624 (56%) 2,923 (100%)
AIDS 2,075 (61%) 1,308 (39%) 3,383 (100%)
Total 3,374 (54%) 2,932 (46%) 6,306 (100%)
HRSA
Health
Resources and
Services
Administration
HRSA defines
HIV/AIDS cases
based on current
residence;
CDC defines
HIV/AIDS cases
by residence at
time of diagnosis.
In 2006,
approximately
43% of persons
living with
HIV/AIDS in the
United States
were out‐of‐care.
53
HIV/STD Service
Oklahoma State
Department of Health
Table 9. Care Status by Race/Ethnicity
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
Race/Ethnicity
Number (%)
In Care Out of Care Total
White 2,088 (54%) 1,760 (46%) 3,848 (100%)
Black 713 (49%) 741 (51%) 1,454 (100%)
Hispanic 227 (48%) 245 (52%) 472 (100%)
Asian/Pacific Islander 23 (51%) 22 (49%) 45 (100%)
American Indian/Alaska Native 229 (63%) 136 (37%) 365 (100%)
Table 10. Care Status by Diagnosis Location,
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
MSA
Number (%)
In Care Out of Care Total
OKC MSA 1,340 (61%) 872 (39%) 2,212 (100%)
Tulsa MSA 819 (57%) 615 (43%) 1,434 (100%)
Lawton MSA 62 (34%) 119 (66%) 181 (100%)
Ft. Smith MSA 37 (60%) 25 (40%) 62 (100%)
NON‐MSA 1,116 (46%) 1301 (54%) 2,417 (100%)
Table 11. Care Status by HIV Diagnosis Age,
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
Age Group
Number (%)
In Care Out of Care Total
1‐12 27 (53%) 24 (47%) 51 (100%)
13‐19 105 (44%) 131 (56%) 236 (100%)
20‐24 484 (50%) 479 (50%) 963 (100%)
25‐29 641 (53%) 578 (47%) 1,219 (100%)
30‐39 1,292 (54%) 1,098 (46%) 2,390 (100%)
40‐49 632 (58%) 462 (42%) 1,094 (100%)
50‐59 158 (56%) 125 (44%) 283 (100%)
60+ 33 (60%) 22 (40%) 55 (100%)
54
55
What is the scope of sexually transmitted
diseases in Oklahoma?
56
Overview
Chlamydia is the most commonly reported notifiable sexually transmitted disease (STD) in
the United States. Caused by the bacterium Chlamydia trachomatis, it also is the most
prevalent STD in Oklahoma, accounting for 74% of reported STDs for 2009.
Oklahoma had an incidence rate of 407 per 100,000 in 2009 with 74% of the reported cases
being female, matching the general gender trend since 1997. Since 1997, the gender gap
has increased slightly, though both genders saw an increase in the number of Chlamydia
cases. Generally, women go to the doctor more frequently than men, due to yearly exams
and pregnancy related appointments; therefore, this could account for disparity among
genders.
Up to 70% of
women with
chlamydia do not
have signs or
symptoms.
Oklahoma
mandated
chlamydia
reporting in
1988, when
2,714 cases
were reported.
In 2009, a total
of 14,991 cases
were reported.
0
100
200
300
400
500
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate per 100,0000 population
Year of Diagnosis
Chart 31. Rates of Chlamydia for
Oklahoma vs. United States, 2000‐2009
U.S Oklahoma
0
2,000
4,000
6,000
8,000
10,000
12,000
2000 2001 2002 2003 2004 2005 2006 2007 *2008 *2009
Numbre of Cases
Year of Diagnosis
Chart 32. Reported Chlamydia Cases in Oklahoma
by Gender, 2000‐2009
*Reports available electronically Male Female
57
HIV/STD Service
Oklahoma State
Department of Health
Chlamydia by Age Group
 Chlamydia occurs in all ages, but age groups 15‐19 years (2,101 per 100,000) and 20‐ 24
years (2,031 per 100,000) had the highest rates among all the age groups in 2009.
 The 20‐24 year age group (5,702 cases) and the 15‐19 age group (5,397 cases) have the
highest number of reported cases.
 Oklahomans ages 20‐24 have consistently had the highest number of cases since 2004.
 Of the 15‐19 years age group, 19 year olds (1,735 cases) have consistently reported the
highest number of cases among all age groups since 1997.
 In 2009, those 18 years old had the second highest number of cases followed by those
20 years old. Both the 18 (1,588 cases) and 20 (1,552 cases) year old age groups have
reported the second or third highest case numbers since 1997.
 Most of the reported Chlamydia cases in Oklahoma since 1997 have been 15 years of
age or older.
Chlamydia by Race
 The Black population had the highest rate among all racial groups with a rate of 1,526
per 100,000, 7 times higher when compared to the White population (220 per
100,000).
 American Indians and Alaska Natives had the second highest rate (505 per 100,000)
which was 2.3 times higher than Whites.
 Asian and Pacific Islanders had a rate of 1,621 per 100,000, but had only 64 cases in
2009 (47% increase from 2008).
0
1000
2000
3000
4000
5000
6000
7000
White Hispanic Black Asian/PI AI/AN
Number of Cases
Race/Ethnicity
Chart 33. Chlamydia Cases by Race/Ethnicity,
Oklahoma 2009
58
 Hispanics had a rate of 414 per 100,000 in 2009, which represents a 17% increase from
2008.
 Though the Black and White populations have both seen an increase in rates/cases
since 1999, the White population has consistently had more reported cases during the
specified time period.
 White females (4,837 cases) reported the highest number of cases in 2009, followed by
Black females (2,933 cases), which follows the general trend since 1997.
 Black males (1,598 cases) reported the third highest total in 2009, followed by
American Indian and Alaska Native females (1,239 cases).
Geographic Distribution of Chlamydia in Oklahoma
 Oklahoma County (4,185 cases) had the highest number of reported Chlamydia cases in
2009, followed by Tulsa (3,357 cases) and Comanche (1,032 cases) Counties.
 Comanche County had the highest rate at 911 per 100,000 population, followed by
Oklahoma county (584 per 100,000), and Tulsa County (559 per 100,000).
 Lawton had the highest ranked zip code (73505) for Chlamydia cases in the state.
 There are 4 major Metropolitan Statistical Areas (MSA) in Oklahoma with the majority
of the Chlamydia morbidity coming from the Oklahoma City MSA, followed by the Tulsa
and the Lawton MSAs.
 The 405 area code reported the most Chlamydia cases compared to the 918 area code
in 2009, which follows the same trend since 1997, though the gap has gotten
increasingly larger.
The rate of
Chlamydia in
Oklahoma
increased 4.4%
between 2008
and 2009, which
follows a trend in
Oklahoma and
the U.S. since
1997.
Oklahoma City
had the highest
number of
reported
Chlamydia cases
in 2009, followed
by Tulsa and
Lawton.
59
60
Overview
Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply in
warm, moist areas of the reproductive tract, mouth, throat, eyes, and anus. In women,
gonorrhea can result in pelvic inflammatory disease, ectopic pregnancy, cervicitis, and
eventually infertility. Pregnant women infected with gonorrhea can also infect their
unborn babies through the amniotic fluid or during birth. In men, this infection most often
manifests as purulent urethral discharge and dysuria, and can cause infertility.
Gonorrhea cases increased from 1943 until 1982, when numbers started to slowly drop
following a national decline due to the implementation of a national gonorrhea control
program in the mid‐1970s. The rate of gonorrhea in Oklahoma decreased 6% between 2008
and 2009, which follows a trend of relatively stable gonorrhea morbidity in Oklahoma and
the United States since 1997. Oklahoma had an incidence rate of 126 per 100,000 in 2009,
with 60% of the reported cases being female. In 1989, men made up the majority of
gonorrhea cases in the U.S, but since 2002 women have made up the majority of cases with
Oklahoma following a similar trend.
Oklahoma 1st
mandated
gonorrhea
reporting in
1943, when
4,715 cases
were reported.
Gonorrhea is the
2nd most
reported STD in
Oklahoma.
In 2009, a total of
4,661 cases
were reported in
Oklahoma.
0
50
100
150
200
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate per 100,000 Population
Year of Diagnosis
Chart 34. Gonorrhea Rates per 100,000 Population,
Oklahoma vs. U.S. 2000‐2009
U.S Oklahoma
**US Data for 2009 not available at time of this report.
61
HIV/STD Service
Oklahoma State
Department of Health
Gonorrhea by Race
 Blacks had the highest rate among all racial groups in 2009 with a rate of 849 per
100,000, 20 times higher when compared to the White population (42 per
100,000).
 American Indians and Alaska Natives had the second highest rate (111 per 100,000)
which was 2.6 times higher than Whites.
 Asian/Pacific Islanders had a rate of 279 per 100,000, but represented only 11 cases
in 2009 (a 46% increase from 2008).
 Hispanics had a rate of 64 per 100,000 in 2009, which represents a 7.8% increase
from 2008.
 Black Oklahomans had the highest decrease in gonorrhea rate, an 11.2% decrease
from 2008.
 Since 1997, there has been a slight increase in the White population and a slight
decrease in the Black population for the number of reported gonorrhea cases in
Oklahoma, though the Black population still reports much higher numbers.
 From 1997 to 2008 Black males reported the highest number of gonorrhea cases
followed by Black females with White females reporting the third most cases.
However, in 2009 Black females reported the highest number of cases followed by
Black males.
0 200 400 600 800 1000 1200
AI/AN
Black
White
Asian/PI
Multi
Hispanic
State Total
Rates per 100,000 population
Race/Ethnicity
Chart 35. Reported Gonorrhea Rates per 100,000
population by Race/Ethnicity, Oklahoma 2008‐2009
2008 RATE /100,000 2009 RATE /100,000
62
Since 1997, most
of the gonorrhea
cases diagnosed
were among
15‐24 year olds.
In 2009, Blacks
has the highest
rate among all
races.
Choctaw
County had the
highest rate of
gonorrhea in
2009.
Gonorrhea by Age Group
 Gonorrhea occurs in all ages, but age groups 15 to 19 years (533 per 100,000) and
20 to 24 years (593 per 100,000) had the highest rates among all age groups.
 Although most age groups had a rate decrease from 2008 to 2009, the 10 to 14 age
group had the only rate increase at 21 per 100,000, 12% higher than 2008 (44 to 50
cases).
 In 1997, Oklahomans ages 15 to 19 years had the highest number of cases. But
since 1999, Oklahomans ages 20 to 24 years have consistently reported higher
numbers, a trend similar to that for Chlamydia.
 Of all ages, 19 year olds have consistently seen a higher number of reported cases
since 1998, followed by the 20 year olds.
 Of all ages, 18 and 20 year old age groups have both been second and third for
number of reported gonorrhea cases, a trend similar to Chlamydia.
0
200
400
600
800
10‐14 15‐19 20‐24 25‐29 30‐34 35‐39 40‐44 45‐49
Rate
Age Group
Chart 36. Reported Gonorrhea by Age Group,
Oklahoma 2008‐2009
2009 RATE /100,000 2008 RATE /100,000
0
1,000
2,000
3,000
4,000
2000 2001 2002 2003 2004 2005 2006 2007 *2008 *2009
Number of Cases
Year of Diagnosis
Chart 37. Reported Gonorrhea Cases in Oklahoma
by Gender, 2000‐2009
*Reports available electronically Male Female
63
HIV/STD Service
Oklahoma State
Department of Health
Geographic Distribution of Gonorrhea in Oklahoma
 While Oklahoma county had the highest number of reported cases, Choctaw
county had the highest rate at 275 per 100,000, followed by Oklahoma county (246
per 100,000), and Tulsa county (244 per 100,000).
 Choctaw County had a 44% rate increase between 2008 and 2009, while Oklahoma
County decreased by 14%, and Tulsa County increased by 2.6%.
 There are 4 major Metropolitan Statistical Areas (MSA) in Oklahoma, with the
majority of the gonorrhea morbidity coming from the Oklahoma City MSA, followed
by the Tulsa and the Lawton MSAs.
 Oklahoma is also split into 3 area codes, each containing a major city with the 405
area code containing Oklahoma City (Oklahoma county), the 918 area code
containing the city of Tulsa (Tulsa county), and the 580 area code containing the
city of Lawton (Comanche county).
 The 405 area code reported the most gonorrhea cases compared to the 918 area
code in 2009. This follows the same trend since 1997 though the gap has
decreased.
 The city of Tulsa had the highest number of reported gonorrhea cases in 2009
followed by Oklahoma City and Lawton, with Tulsa having 2 out of the top three zip
codes for gonorrhea cases in the state (including the highest ranked zip code).
64
Overview
The development of ARG is a growing public health concern, in particular because
only one remaining class of antibiotics is recommended for its treatment. Currently,
the CDC recommends that cephalosporin antibiotics be used to treat all gonococcal
infections in the United States. Historically, gonorrhea has progressively developed
resistance to the antibiotic drugs prescribed to treat it. These drugs include
penicillin, tetracycline, and ciprofloxacin. Thus, it is critical to continuously monitor
antibiotic resistance of gonorrhea, and encourage research and development of new
treatment regimens.
Surveillance
Surveillance for ARG and the establishment of gonococcal treatment guidelines in
the United States are conducted through the GISP, which was established in 1986.
Approximately 25‐30 sites, and 4‐5 regional laboratories across the U.S. participate
in GISP, and data from this project have been reported and have directly contributed
to CDC's STD Treatment Guidelines since 1989. Oklahoma County is a participating
GISP site.
Trends
Overall in 2008, 24% of isolates collected from 29 GISP sites were resistant to
penicillin, tetracycline, ciprofloxacin, or some combination of those antibiotics. In
1993, ciprofloxacin, along with ceftriaxone and cefixime (drugs that are types of
cephalosporins) were among the recommended treatments for gonorrhea. However,
in the late 1990s and early 2000s, ciprofloxacin resistance began to arise in Hawaii
and the West Coast of the continental U.S.
By 2004, ciprofloxacin resistance was elevated in men who have sex with men
(MSM). In 2006, 13.8% of isolates exhibited resistance to ciprofloxacin. Ciprofloxacin
resistance was present in all regions of the country, including the heterosexual
population. On April 13, 2007, CDC stopped recommending fluoroquinolones as
treatment for gonococcal infections for all persons in the United States.
Susceptibility testing for the cephalosporin class of drugs is currently being
conducted by GISP on ceftriaxone, cefixime, and cefpodoxime.
ARG
Antimicrobial
Resistance in
Neisseria
gonorrhoeae
GISP
Gonococcal
Isolate
Surveillance
Project
65
HIV/STD Service
Oklahoma State
Department of Health
Challenges
A major challenge to monitoring emerging antimicrobial resistance in gonorrhea is
the substantial decline in capability of laboratories to perform essential gonorrhea
culture techniques required for antibiotic susceptibility testing. This decline results
from an increased use of newer laboratory technology such as a diagnostic test
called the Nucleic Acid Amplification Test (NAAT), which is not culture‐based.
Currently, there is no reliable technology that allows for antibiotic susceptibility
testing from non‐culture specimens and increased laboratory culture capacity is
needed.
Information provided by Centers for Disease Control and Prevention‐ Division of STD Prevention.
66
Overview
Syphilis is a sexually transmitted disease (STD) caused by the bacteria Treponema
Pallidum. Syphilis is transmitted from person to person through direct contact with a
syphilis lesion. Symptoms of syphilis differ according to the disease stage. Many people
have no symptoms for years, yet remain at risk for complications if not treated.
There are three stages of syphilis infection: primary, secondary, and latent. The latent
stage of syphilis can be divided into early latent, late latent, and unknown duration.
During primary syphilis infection, an ulcer (called chancre ["shan‐ker"]) typically appears
within 10 to 90 days (an average 21 days) after exposure. These chancres usually
disappear within a few weeks whether treated or not.
Symptoms of secondary syphilis are a rash of lesions anywhere on the body (including the
palms of the hands and soles of the feet), along with broad‐based papules (lumps or
warts) in warm, moist sites. Mucous patches or snail‐track ulcers (sores) can develop in
the mouth, appearing several weeks after the chancre develops. Flu‐like symptoms can
also occur during secondary syphilis. Up to 15% of individuals with untreated syphilis
may develop latent syphilis from 10 to 20 years after the initial infection.
The latent stage of syphilis begins when primary and secondary symptoms disappear;
these final stages can last for years. If left untreated, an infected person will continue to
have syphilis although there are no signs or symptoms. During the final stages of syphilis,
the disease may damage the internal organs, including the brain, heart, blood vessels,
bones, and joints. Signs and symptoms of the late stage of syphilis include paralysis,
blindness, dementia, and even death. Neurosyphilis can occur during any stage of
syphilis. In this article, early syphilis is defined as a case of primary, secondary, or early
latent syphilis.
In 2009, there
were a total of
263 reported
early syphilis
cases in
Oklahoma.
The syphilis rate
in Oklahoma
increased
16.2% between
2008 and 2009.
The Oklahoma
County rate was
3.1 times higher
than the state
rate.
0
2
4
6
8
10
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate per 100,000 Population
Year of Diagnosis
Chart 38. Early Syphilis Rates per 100,000
Population, Oklahoma vs. U.S. 2000‐2009
*US Data for 2009 not available as time of this report. U.S Oklahoma
**Early Syphilis is defined as primary, secondary, and early latent syphilis.
67
HIV/STD Service
Oklahoma State
Department of Health
Although Oklahoma saw an increase over the past year, there has been an overall
decrease since 1997 in Oklahoma and the United States.
 Oklahoma had an incidence rate of 7 per 100,000 in 2009 with 60.9% of the
reported cases being male.
 Oklahoma County had the highest number of reported cases and the highest rate
at 22 per 100,000.
 Comanche County had the second highest rate (14.1 per 100,000) followed by
McCurtain County (12 per 100,000).
 Comanche County had the highest rate increase of all the counties in Oklahoma.
Early Syphilis by Age Group
 Syphilis occurs in all ages, but age groups 20‐24 years (21.7 per 100,000) and 25‐ 29
years (18.9 per 100,000) had the highest rates among all the age groups in 2009.
 The 20‐24 year age group and the 15‐19 age group had the highest number of
reported cases.
 In 2009, 69% of the early syphilis cases were between the ages of 20 and 39, with 44%
between the ages of 20 and 29.
 Age group 45‐49 year had the biggest decrease from 2008 (56.2%).
 The 20 year old age group reported the second highest number of cases among all
age groups in 2009.
 Most age groups had an increase from 2008 to 2009 with the 35 to 39 age group
having the highest rate increase, 34% higher than 2008 (21 to 32 cases).
 In 1997, persons 27 and 28 years of age reported the highest number of cases.
0
5
10
15
20
25
15���19 20‐24 25‐29 30‐34 35‐39 40‐44 45‐49 50+
Rate
Age Group
Chart 39. Reported Early Syphilis* by Age Group,
Oklahoma 2008‐2009
2009 RATE /100,000 2008 RATE /100,000
*Early Syphilis includes Primary, Secondary, and Early Latent Syphilis.
68
Those 24 years
old reported the
highest
number of cases
among all age
groups in 2009.
Black males have
consistently
reported the
highest
number of cases
since 1997.
The Comanche
County rate
increased 68%
from 2008 to
2009.
Early Syphilis by Race
 The Black, White, and American Indian and Alaska Native populations in Oklahoma
reported 95% of the syphilis cases in 2009.
 Blacks had the highest rate among all racial groups for early syphilis with a rate of
41.4 per 100,000 population, 11 times higher when compared to the Whites (3.62 per
100,000).
 American Indian and Alaska Natives had the second highest rate (5.74 per 100,000)
which was 1.6 times higher than Whites.
 Hispanics had a rate of 8.28 per 100,000 in 2009, which represents a 13% decrease
from 2008.
 Blacks reported the biggest increase from 2008 (28%), while the American Indian and
Alaska Natives reported the biggest decrease (13.6%).
 In 2009, Black males (74) reported the most cases followed closely by White males
(68).
Geographic Distribution of Early Syphilis in Oklahoma
 Oklahoma includes 77 counties, with Oklahoma county having the highest number of
reported early syphilis cases in 2009, followed by Tulsa and Comanche counties.
 Oklahoma County had the highest rate at 22 per 100,000 population, followed by
Comanche County (14.1 per 100,000) and McCurtain County (12 per 100,000).
 The majority of early syphilis cases (62%) were reported from Oklahoma County.
 The 405 area code reported the most early syphilis cases, which follows the same
trend since 1997.1
 Oklahoma City had the highest number of reported syphilis cases in 2009 followed by
Tulsa and Lawton, with Oklahoma City having the highest ranked zip code (73107) for
syphilis cases in the state.
1The 580 and 405 area codes have been combined for this analysis and are both collectively called the 405 area code.
0
10
20
30
40
50
AI/AN Black White Hispanic
Rate
Race
Chart 40. Early Syphilis Rate per 100,000
by Race/Ethnicity, Oklahoma 2008‐2009
2009 Rate 2008 Rate
69
70
Overview
During 2009, Oklahoma experienced a syphilis outbreak in Oklahoma County. In
March of 2009, three high school students between the ages of 15 to 17 were
reported to the Oklahoma City County Health Department with early syphilis. Within
days, another 17 year old was reported with primary syphilis in the central Oklahoma
area. Upon further investigation, the reporting county health department nurse
stated her county had seen a few cases of early syphilis among teens the previous
week.
By August of 2009, there were a total of 36 cases in the outbreak. Twenty‐two of
these cases were diagnosed as early latent syphilis with 9 secondary syphilis cases, 4
primary syphilis cases, and 1 late latent syphilis case. The majority (58%) of the cases
were among males. Blacks accounted for 67% of the outbreak, followed by Whites
(33%) and Hispanics (11%). Although the first outbreak cases were among 15‐17
year olds, the outbreak age ranged from 14 ‐45 years of age with a median age of 21
years.
Heterosexual contact was identified as the only risk activity for 42% of those involved
in the outbreak. Men who have sex with men accounted for 30% of the outbreak
cases. The additional 28% had a risk identified as a combination of heterosexual
contact, sex while intoxicated or high, anonymous sex, or bisexual contact.
Outbreak Response
The OSDH HIV/STD Service deployed all DIS to Oklahoma County to ensure proper
timelines were achieved. Health educators from the HIV Prevention and
Intervention Division worked directly with the Oklahoma Department of Education,
local county health departments, and the Oklahoma School Nurses Association to
increase education and awareness of STDs to area teens. The Oklahoma Health Alert
Network (OKHAN) was also used to provide information to physicians and emergency
departments across Oklahoma.
A press release was also issued to alert the public. This press release resulted in 13
interviews and five follow‐up stories broadcasted on local media stations across
Oklahoma. Presentations were provided to local community partners and
organizations, including affected high schools. Four DIS and two health educators
performed onsite screening and counseling services at a popular hangout named by
multiple positive youth.
March 25, 2009
Press Release
“The Oklahoma
State Department
of Health
announced today
that it has
identified an
outbreak of
syphilis occurring
among teenagers
younger than age
18 in the central
Oklahoma area.”
71
HIV/STD Service
Oklahoma State
Department of Health
Table 12. Oklahoma Syphilis Outbreak
Investigation In 2009
Number Percent
Gender
Male 22 61%
Female 14 39%
Race
Black 24 67%
White 12 33%
Ethnicity
Hispanic 4 11%
Non‐Hispanic 32 89%
Mode of Transmission
Heterosexual Only 15 42%
MSM 11 30%
Combination 10 28%
*Combination is defined as two or more of the following: heterosexual, sex
while high or intoxicated, anonymous sex, or bisexual females.
72
Overview
In 2009, 43 Oklahomans were diagnosed with both HIV/AIDS and syphilis. This was a
major increase since 2000, when only nine cases were diagnosed. Of the 43 cases
diagnosed, 30 (70%) were classified as HIV and 13 (30%) were classified as AIDS.
Forty‐four percent (19) of cases had a syphilis diagnosis of latent syphilis, followed
by 42% (18) of secondary syphilis, and 14% (6) of primary syphilis.
The majority of cases were male (93%), with only 7% being female. Age group 20‐29
year olds accounted for 58% of the cases, followed by 40‐49 year olds (16%), and 30‐
39 year olds (12%). Age group 13‐19 year olds accounted for 9% and 50‐59
accounted for 5% of the co‐morbidity cases.
 While Whites (40%) made up the largest percentage of cases, Blacks (35%) and
Hispanics (19%) also accounted for a significant amount . Persons of multi‐race
and American Indians/Alaska Natives accounted for less than 7% combined.
 Oklahoma, Comanche, and Tulsa Counties were the top three counties for co‐morbidity
of HIV/AIDS and Syphilis, with Oklahoma County accounting for 41% of
the cases.
 The top four zip codes with co‐morbidities are as follows (in order): 73107,
73505, 73106, and 73120.
Since 2000, there
has been almost
a 400% increase
in co‐morbidity
cases of HIV and
Syphilis.
MSM and MSM &
IDU accounted
for 77% of the
cases.
0
2
4
6
8
10
12
14
White Black Hispanic AI/AN Multi
Number of Cases
Race/Ethnicity
Chart 41. HIV/AIDS and Syphilis Co‐morbidity Cases
by Race and HIV Diagnosis, Oklahoma 2000‐2009
AIDS
HIV
*AI/AN ‐ American Indian/Alaska Native
73
74
Acute Hepatitis B
2009 Case Total:
122
Acute Hepatitis B
2009 Rate:
3.3 per 100,000
Hepatitis B
vaccine has been
available since
1982.
Overview
Hepatitis B is a virus that enters the bloodstream and then infects the liver. It is most
often spread from person to person through contact with infected semen, vaginal
secretions, or blood. Symptoms of hepatitis B may be mild or very severe and include
being very tired, nausea, vomiting, fever, stomach pain, and yellowing of the skin and
eyes. It can take anywhere from two to six months after exposure before the
symptoms of infection appear, however about 30% of infected people do not
develop symptoms and may not know they are infected.
Most adults with hepatitis B will get rid of the virus within four to six months and are
no longer capable of giving the infection to others. However, about 1 out of every 10
infected adults, and as many as 9 out of 10 babies will become chronically infected
with hepatitis B, which means they do not get rid of the virus. Most chronically
infected persons do not look or feel sick. However, they may eventually develop
serious liver diseases such as cirrhosis (scarring) or liver cancer.
For the second year in a row, acute hepatitis B cases in Oklahoma decreased by 5.4%
from 2008 to 2009, from 129 cases to 122 cases. The continuation of the Hepatitis
Vaccine Initiative—a collaborative effort between OSDH, the Oklahoma Department
of Corrections, and the Centers for Disease Control—may be a factor in the reduction
of reported cases. The OSDH has also partnered with a metro area medical clinic for
the homeless to provide combination hepatitis A/B vaccines to a high risk
population.
By Gender
 64 (52%) were males and
 48 (48%) were female.
By Race
 79 Whites (2.8 per 100,000),
 24 American Indians and Alaska Natives (8.2 per 100,000),
 6 Black or African Americans (2.1 per 100,000),
 2 Asians (3.1 per 100,000),
 1 Hawaiian/Other Pacific Islander (25.9 per 100,000), and
 10 cases reported as Unknown race.
By Risk Factor
 64 (52%) reported a risk factor of 2 or more sexual partners.
 38 (31%) reported more than 5 sexual partners.
75
HIV/STD Service
Oklahoma State
Department of Health
Perinatal Hepatitis B
In 2009, a total of 95 babies were born to hepatitis B surface antigen positive women
in Oklahoma. This was a 42% increase from 2008, with 67 live births. There are
several likely explanations for this increase—
 better disease reporting as more laboratories are submitting their results
electronically;
 a greater awareness of the disease; and
 an increase in persons from areas where the disease is endemic (ex: Sub‐
Saharan Africa and Southeast Asia).
According to Oklahoma’s population demographics, the CDC estimated that
Oklahoma should have had approximately 160 cases reported in 2009. Oklahoma
will most likely see the number of deliveries to hepatitis B positive women continue
to increase in the future. Although it is alarming, chronic cases of hepatitis B have
remained fairly constant. The way to decrease the future cases is to increase
awareness and vaccinate infants appropriately.
The CDC recommends a “universal birth” dose policy for all delivery hospitals. In
Oklahoma, there were 76 delivery hospitals and only 50% of them had a universal or
a standing order for administration of hepatitis B vaccine to infants before discharge.
It is recommended that infants born to hepatitis B positive women be given hepatitis
B immune globulin (HBIG) and hepatitis B vaccine within 12 hours of birth.
During 2009 in Oklahoma,
 77% of babies born received both injections within 12 hours,
 85% received both injections within 24 hours, and
 92% received both injections within 48 hours of birth.
 52% of infants had received HBIG and all three hepatitis B vaccines by 12
months of age.
 21% of the reported infants were serologically tested by 15 months of age.
The ages of the women who were hepatitis B surface antigen positive and who
delivered infants ranged from 16 to 44 years. Fifty‐eight percent of delivering women
were between 30 and 40 years of age. Thirty‐nine percent were between 20 and 30
years of age and three percent were under 20 years of age.
76
2009 Acute
Hepatitis C
Case Total: 27
2009 Acute
Hepatitis C
Case Rate:
0.7 per 100,000
Oklahoma Acute
Hepatitis C
Incidence Rate is
2 times higher
than the US
average.
Overview
Hepatitis C can be either classified as acute or chronic, but the CDC currently collects
only reports of acute hepatitis C infection. The acute (newly acquired) form is a
short‐term illness that occurs within the first 6 months after a person is exposed to
the hepatitis C virus (HCV) which causes hepatitis C; however, the disease can
become chronic. Of 100 HCV‐infected people, 75 to 85 will develop chronic (long‐lasting)
infection and 70 people will eventually develop chronic liver disease.
Although less than 3% of chronically infected persons die as a result of their
infection, hepatitis C remains the leading indication for liver transplantation.
People who received a blood transfusion before 1992, as well as, past or current
injection‐drug users, are at risk for chronic hepatitis C and should be screened for the
disease. Chronic HCV infection progresses slowly over the course of a 15‐30 year
period and can lead to cirrhosis of the liver or liver cancer. Eight thousand to ten
thousand deaths occur annually in the United States as a result of chronic HCV
infection.
For 2009, there was a 29% increase of confirmed cases of acute hepatitis C, from 21
cases in 2008 to 27 cases in 2009. Based on the most current CDC data, 2007,
Oklahoma’s case rate (0.7 per 100,000) is above the national rate (0.3 per 100,000)
for confirmed cases of acute hepatitis C. In Oklahoma, currently HCV case
investigation is limited to cases in persons 40 years of age and younger.
Demographics
 Cases of acute hepatitis C ranged in age from 18 years to 54 years.
 Eleven (41%) of the total cases were located in three large metropolitan
counties—Oklahoma, Tulsa and Cleveland.
 The highest number of cases, 12 (44%), occurred among 25‐34 year olds.
 Age groups of the remaining cases were as follows:
o 1(3%) 18 years of age,
o 2 (7%) 20 to 24 years,
o 7 (26%) 35 to 44 years, and
o 5 (19%) 45 to 54 years.
 There were 15 females (56%) and 12 males (44%) infected with confirmed
acute hepatitis C.
 The confirmed acute hepatitis C cases broken down by race were:
o Whites 20 (0.7 per 100,000),
o American Indian and Alaska Natives 4 (1.4 per 100,000), and
o Unknown race 3.
77
HIV/STD Service
Oklahoma State
Department of Health
CDC states that “of the cases reported in 2007 for which information concerning
exposures during the incubation period was available, the most common risk factor
identified was IDU (48%). During 1998–2007, IDU was reported for an average of
44% of persons (range: 38%–54%)”.
The risk factors most frequently reported in the 2009 Oklahoma cases were:
 IDU (52%),
 Other drug use besides IDU (48%),
 Tattoos (59%), and
 2 or more sexual partners (37%).
Eighteen (67%) of the cases reported at least 2 or more of the most frequently
reported risk factors needed.
Information provided by Centers for Disease Control and Prevention‐ Division of STD Prevention.
White
74%
AI/AN
15%
Unknown
11%
Chart 42. Confirmed Acute Hepatitis C Cases
In Oklahoma for 2009
78
Overview
In 2009, 36 Oklahomans had been diagnosed with both HIV/AIDS and Hepatitis B or
C. The majority (75%) were diagnosed with Hepatitis C (past or present), followed by
19% Chronic Hepatitis B, and 6% Acute Hepatitis B.
Eighty‐three percent of cases were males, and 17% were females. Forty‐six percent
of cases were MSM, 18% were MSM & IDU, 21% were IDU, and 3% were
heterosexual. Twelve percent of cases had an unknown risk.
Whites (69%) accounted for the largest percent of co‐morbidity cases, followed by
Blacks (22%), American Indians/Alaska Natives (6%), Hispanics (6%), and unknown
race (3%).
The age group breakdown of HIV/AIDS and Hepatitis B/C co‐morbidity are as follows:
 30‐39 year olds accounted for 45% (16),
 40‐49 year olds accounted for 28% (10),
 Age 50 and above accounted for 19% (7), and
 20‐29 year olds accounted for 8% (3).
Geographic Distribution in Oklahoma
 Oklahoma (10) and Tulsa (6) counties accounted for almost half (44%) of the co‐morbidity
cases.
 The top two Oklahoma cities with the largest number of co‐morbidity cases were
Oklahoma City (8) and Tulsa (7).
Acute Hep B
6%
Chonic
Hep B
19%
Hep C
75%
Chart 43. HIV/AIDS Cases Newly Diganosed with
Hepatitis B or C, Oklahoma 2009
Co‐Morbidity
is defined as the
presence of one
or more diseases.
64% of cases
were either MSM
or MSM & IDU.
Oklahoma males
accounted for the
majority of
cases.
79
80
81
82
Table 1. Prevalence (Persons Living) Estimates for HIV/AIDS Cases,
Rates by County, Oklahoma 2009
COUNTY
HIV CASES AIDS CASES
Number Rate Number Rate
Adair 4 18.30 7 32.03
Alfalfa * 17.97 * 17.97
Atoka 3 20.59 8 54.90
Beaver * * * 19.08
Beckham 7 32.57 3 13.96
Blaine 10 78.94 7 55.26
Bryan 13 32.13 16 39.54
Caddo 26 88.65 15 51.14
Canadian 41 38.41 47 44.03
Carter 13 27.24 14 29.34
Cherokee 6 13.14 13 28.47
Choctaw 8 53.75 6 40.31
Cimarron * * * *
Cleveland 160 66.51 108 44.89
Coal * 17.63 * 35.26
Comanche 143 127.40 49 43.65
Cotton * 15.96 * 31.91
Craig 5 33.11 11 72.84
Creek 22 31.65 22 31.65
Custer 9 34.26 8 30.45
Delaware 4 9.89 7 17.30
Dewey * 45.29 * 45.29
Ellis * * * *
Garfield 23 39.62 19 32.73
Garvin * 7.37 10 36.86
Grady 17 33.27 17 33.27
Grant * * * 22.48
Greer 4 68.73 4 68.73
Harmon * * * 35.29
Harper * 29.54 * *
Haskell * 8.15 6 48.92
Hughes 4 29.35 3 22.01
Jackson 6 23.68 9 35.52
Jefferson 4 64.20 3 48.15
Johnston 4 38.36 3 28.77
Kay 18 39.23 13 28.33
Kingfisher 3 21.03 * 14.02
Kiowa * * 3 32.45
Latimer * 9.46 4 37.82
Le Flore 20 40.16 22 44.17
Lincoln 7 21.83 9 28.06
Logan 25 65.06 17 44.24
Love 3 32.98 * 21.99
83
1. Cells represented by an asterisk (*) are not reported due to privacy concerns.
2. Rates have been calculated per 100,000 population using the 2008 US Census Data. 2009 Census Data was not available at the time
this table was created.
McClain 8 24.63 15 46.17
McCurtain 8 23.89 10 29.86
McIntosh 5 25.47 7 35.66
Major 3 42.06 * *
Marshall 5 33.43 * 13.37
Mayes 4 9.98 11 27.44
Murray * 7.82 * 7.82
Muskogee 23 32.51 32 45.23
Noble 7 63.64 * 9.09
Nowata 3 27.97 4 37.30
Okfuskee 3 27.01 7 63.02
Oklahoma 955 135.25 925 131.00
Okmulgee 8 20.46 15 38.36
Osage 16 35.40 27 59.73
Ottawa 8 25.28 9 28.44
Pawnee 5 30.66 9 55.18
Payne 25 31.75 21 26.67
Pittsburg 12 26.80 16 35.73
Pontotoc 9 24.36 8 21.65
Pottawatomie 21 30.23 33 47.51
Pushmataha * 8.57 * 17.14
Roger Mills * * * *
Rogers 27 31.97 20 23.68
Seminole 9 37.33 6 24.89
Sequoyah 11 26.77 15 36.51
Stephens 9 20.76 10 23.07
Texas 8 38.89 4 19.44
Tillman * 12.61 * 12.61
Tulsa 637 107.53 701 118.33
Wagoner 11 15.93 10 14.48
Washington 6 11.87 16 31.65
Washita * 8.55 * *
Woods * 11.93 * *
Woodward 5 25.34 4 20.27
Unknown 5 * * *
STATE OF OKLAHOMA 2,483 68.14 2,441 66.99
84
Table 2. Estimated Distribution of Newly Diagnosed HIV/AIDS cases in Oklahoma for 2009
COUNTY 2008 Population Est. Cases
Rate/100,000
Population
State 3,644,025 312 8.56
Adair 21,857 * 0.00
Alfalfa 5,565 * 0.00
Atoka 14,573 * 0.00
Beaver 5,242 * 0.00
Beckham 21,494 * 0.00
Blaine 12,668 * 0.00
Bryan 40,463 3 7.41
Caddo 29,329 3 10.23
Canadian 106,755 12 11.24
Carter 47,716 * 0.00
Cherokee 45,667 * 0.00
Choctaw 14,885 * 13.44
Cimarron 2,585 * 0.00
Cleveland 240,568 20 8.31
Coal 5,672 * 0.00
Comanche 112,249 11 9.80
Cotton 6,267 * 0.00
Craig 15,101 * 13.24
Creek 69,514 6 8.63
Custer 26,272 * 3.81
Delaware 40,463 * 2.47
Dewey 4,416 * 0.00
Ellis 3,877 * 0.00
Garfield 58,053 * 3.45
Garvin 27,128 3 11.06
Grady 51,099 * 3.91
Grant 4,448 * 0.00
Greer 5,820 * 17.18
Harmon 2,834 * 0.00
Harper 3,385 * 0.00
Haskell 12,266 * 0.00
Hughes 13,630 3 22.01
Jackson 25,336 * 7.89
Jefferson 6,231 * 0.00
Johnston 10,428 * 9.59
Kay 45,886 * 4.36
Kingfisher 14,264 * 7.01
Kiowa 9,246 * 0.00
85
Latimer 10,576 * 0.00
Le Flore 49,806 4 8.03
Lincoln 32,070 * 3.12
Logan 38,424 8 20.82
Love 9,097 * 10.99
McClain 32,487 * 0.00
McCurtain 33,489 * 2.99
McIntosh 19,629 * 5.09
Major 7,132 * 0.00
Marshall 14,958 * 6.69
Mayes 40,084 * 0.00
Murray 12,787 * 7.82
Muskogee 70,750 * 2.83
Noble 11,000 * 0.00
Nowata 10,725 * 0.00
Okfuskee 11,107 * 9.00
Oklahoma 706,116 102 14.45
Okmulgee 39,100 * 0.00
Osage 45,203 16 35.40
Ottawa 31,644 * 3.16
Pawnee 16,310 * 0.00
Payne 78,733 4 5.08
Pittsburg 44,776 4 8.93
Pontotoc 36,948 * 2.71
Pottawatomie 69,464 4 5.76
Pushmataha 11,672 * 0.00
Roger Mills 3,370 * 0.00
Rogers 84,464 7 8.29
Seminole 24,110 * 0.00
Sequoyah 41,089 * 4.87
Stephens 43,351 * 0.00
Texas 20,573 * 0.00
Tillman 7,928 * 0.00
Tulsa 592,406 68 11.48
Wagoner 69,040 * 2.90
Washington 50,556 * 0.00
Washita 11,691 * 0.00
Woods 8,379 * 0.00
Woodward 19,729 * 0.00
Unknown 0 * 0.00
STATE OF OKLAHOMA 3,644,025 312 8.56
1. Cells represented by an asterisk (*) are not reported due to privacy concerns.
2. Rates have been calculated per 100,000 population using the 2008 US Census Data. 2009 Census Data was not available at the time
this table was created.
86
Table 3. Reportable Sexually Transmitted Diseases by County, Oklahoma 2009
COUNTY
CHLAMYDIA GONORRHEA EARLY SYPHILIS
Number Rate Number Rate Number Rate
Adair 69 316 6 28 * *
Alfalfa 4 71 * * * *
Atoka 51 348 9 61 * *
Beaver 10 191 * * * *
Beckham 103 487 14 66 * *
Blaine 21 166 * * * *
Bryan 168 419 23 57 * *
Caddo 97 334 10 34 * *
Canadian 202 190 50 47 4 3.8
Carter 165 344 36 75 * *
Cherokee 200 437 40 87 * *
Choctaw 81 544 41 275 * *
Cimarron * * * * * *
Cleveland 580 242 141 59 11 4.6
Coal 7 122 * * * *
Comanche 1,032 923 207 185 16 14.3
Cotton 21 339 * * * *
Craig 51 337 8 53 * *
Creek 202 289 49 70 * *
Custer 64 242 14 53 * *
Delaware 91 225 * * * *
Dewey 5 114 * * * *
Ellis 9 227 * * * *
Garfield 271 466 43 74 4 6.9
Garvin 56 206 9 33 * *
Grady 129 253 35 69 * *
Grant 4 90 * * * *
Greer 22 385 * * * *
Harmon 5 176 * * * *
Harper 6 182 * * * *
Haskell 24 197 * * * *
Hughes 33 242 9 66 * *
Jackson 115 456 20 79 * *
Jefferson 11 177 * * * *
87
Johnston 20 194 * * * *
Kay 66 145 9 20 * *
Kingfisher 28 196 4 28 * *
Kiowa 29 309 * * * *
Latimer 35 331 5 47 * *
Le Flore 155 311 20 40 4 8.*
Lincoln 74 230 11 34 * *
Logan 173 454 44 115 * *
Love 25 273 4 44 * *
Major 13 183 * * * *
Marshall 26 174 * * * *
Mayes 108 271 15 38 * *
Mcclain 62 192 15 46 * *
Mccurtain 173 516 47 140 4 11.9
Mcintosh 55 279 14 71 * *
Murray 23 180 * * * *
Muskogee 285 400 101 142 * *
Noble 21 188 6 54 * *
Nowata 20 186 * * * *
Okfuskee 29 260 7 63 * *
Oklahoma 4,185 592 1,738 246 158 22.4
Okmulgee 149 380 48 122 * *
Osage 84 185 14 31 * *
Ottawa 106 333 14 44 * *
Pawnee 38 233 9 55 * *
Payne 344 439 51 65 * *
Pittsburg 157 348 22 49 * *
Pontotoc 121 327 47 127 * *
Pottawatomie 249 358 53 76 * *
Pushmataha 13 111 * * * *
Roger Mills 6 176 * * * *
Rogers 177 210 29 34 * *
Seminole 79 326 27 112 * *
Sequoyah 139 339 9 22 * *
Stephens 107 246 20 46 * *
Texas 26 128 * * * *
Tillman 19 241 * * * *
Tulsa 3,367 569 1,444 244 26 4.4
88
Wagoner 109 158 29 42 * *
Washington 116 230 6 12 * *
Washita 12 102 * * * *
Woods 13 154 * * * *
Woodward 46 232 5 25 * *
STATE OF OKLAHOMA 14,991 412 4,661 128 256 7
1. Early Syphilis includes primary, secondary and early latent syphilis only.
2. Cells with less than 3 cases have been suppressed for confidentiality reasons.
3. Rates have been calculated per 100,000 population using the 2008 US Census Data. 2009 Census Data was not available at
the time this table was created.
89
Table 4. Cumulative HIV/AIDS Cases Diagnosed in Oklahoma
By Race/Ethnicity and Sex as of 2009
Race/Ethnicity Male Female Total
White 4,680 640 5,320
Black 1,359 344 1,703
Hispanic, All Races 394 75 469
Asian/Pacific Islander 32 10 42
American Indian/Alaska Native 422 100 522
Multiple Races 94 31 125
Table 5. Living HIV/AIDS Cases Diagnosed in Oklahoma
By Race/Ethnicity as of 2009
Race/Ethnicity AIDS HIV Total
White 1,476 1,497 2,973
Black 534 616 1,150
Hispanic, All Races 186 172 358
Asian/Pacific Islander 16 17 33
American Indian/Alaska Native 177 131 308
Multiple Races 52 50 102
90
Table 7. Top 3 Counties of Newly Diagnosed HIV Counseling, Testing, and
Referral in Oklahoma for 2009
By Number of Cases By Rate per 100,000
1 Oklahoma Roger Mills
2 Tulsa Tulsa
3 Cleveland Oklahoma
Table 6. Top Five Counties of Newly Diagnosed HIV/AIDS Cases
in Oklahoma for 2009
By Number of Cases By Rate per 100,000
1 Oklahoma Osage
2 Tulsa Hughes
3 Cleveland Logan
4 Osage Oklahoma
5 Canadian Tulsa
*Counties with less than 3 cases were removed from the analysis for confidentiality reasons.
91
Table 8. Care Status by Diagnosis
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
Diagnosis In Care
Number (%)
Out of Care
Number (%)
Total
Number (%)
HIV 1,299 (44%) 1,624 (56%) 2,923 (100%)
AIDS 2,075 (61%) 1,308 (39%) 3,383 (100%)
Total 3,374 (54%) 2,932 (46%) 6,306 (100%)
Table 9. Care Status by Race/Ethnicity
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
Race/Ethnicity
Number (%)
In Care Out of Care Total
White 2,088 (54%) 1,760 (46%) 3,848 (100%)
Black 713 (49%) 741 (51%) 1,454 (100%)
Hispanic 227 (48%) 245 (52%) 472 (100%)
Asian/ Pacific Islander 23 (51%) 22 (49%) 45 (100%)
American Indian/ Alaska Native 229 (63%) 136 (37%) 365 (100%)
92
Table 10. Care Status by Diagnosis Location,
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
MSA
Number (%)
In Care Out of Care Total
OKC MSA 1,340 (61%) 872 (39%) 2,212 (100%)
Tulsa MSA 819 (57%) 615 (43%) 1,434 (100%)
Lawton MSA 62 (34%) 119 (66%) 181 (100%)
Ft. Smith MSA 37 (60%) 25 (40%) 62 (100%)
NON‐MSA 1,116 (46%) 1301 (54%) 2,417 (100%)
Table 11. Care Status by HIV Diagnosis Age,
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
Age Group
Number (%)
In Care Out of Care Total
1‐12 27 (53%) 24 (47%) 51 (100%)
13‐19 105 (44%) 131 (56%) 236 (100%)
20‐24 484 (50%) 479 (50%) 963 (100%)
25‐29 641 (53%) 578 (47%) 1,219 (100%)
30‐39 1,292 (54%) 1,098 (46%) 2,390 (100%)
40‐49 632 (58%) 462 (42%) 1,094 (100%)
50‐59 158 (56%) 125 (44%) 283 (100%)
60+ 33 (60%) 22 (40%) 55 (100%)
93
Table 12. Oklahoma Syphilis Outbreak Investigation In 2009
Number Percent
Gender
Male 22 61%
Female 14 39%
Race
Black 24 67%
White 12 33%
Ethnicity
Hispanic 4 11%
Non‐Hispanic 32 89%
Mode of Transmission
Heterosexual Only 15 42%
MSM 11 30%
Combination 10 28%
*Combination is defined as two or more of the following: heterosexual, sex while high or intoxicated, anonymous
sex, or bisexual females.
94
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
White Black American
Indian
Asian/Pacific
Islander
Other Multiple
Race
Number of People
Race Group
Chart 1. Race Distribution of People
in Oklahoma for 2009*
*2009 American Community Survey 1‐Year Estimates
0
100,000
200,000
300,000
400,000
500,000
600,000
0‐9 10‐14 15‐19 20‐24 25‐34 35‐44 45‐54 55‐64 65+
Number of People
Age Group (in years)
Chart 2. Age Distribution of People
in Oklahoma for 2009*
*2009 American Community Survey 1‐Year Estimates
95
0
50,000
100,000
150,000
200,000
250,000
300,000
Less than
$15K
$15K to
$24K
$25K to
$34K
$35K to
$49K
$50K to
$74K
$75K to
$99K
$100K to
$149K
$150K to
$199K
$200K or
more
Number of People
Annual Income (in Dollars)
Chart 3. Income Distribution of People in
Oklahoma for 2009*
*2009 American Community Survey 1‐Year Estimates
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
9th to 12th
grade, no
diploma
High school
graduate
Some college,
no degree
Associate's
degree
Bachelor's
degree
Graduate or
professional
degree
Number of People
Educational Attainment
Chart 4. Education Distribution of People in
Oklahoma for 2009
*2009 American Community Survey 1‐Year Estimates
96
0
1000
2000
3000
4000
5000
6000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of cases
Year of Diagnosis
Chart 5. HIV and AIDS Cases Diagnosed in Oklahoma
by Year, Incidence vs. Prevalence for 1999 ‐2009
Incidence Prevelance
Unknown
12<
13‐19
20‐29
30‐39
40‐49
50‐59
60+
0 500 1000 1500 2000 2500 3000 3500
Age at Diagnosis
Number of Cases
Chart 6. Cumulative HIV/AIDS in Oklahoma as of 2009
97
0
20
40
60
80
100
120
140
160
180
200
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 7. New HIV/AIDS Cases Among Males by Race,
Oklahoma 2000‐2009
White
Black
Hispanic
AI/AN
Asian/PI
Multi
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Number of Cases
Mode of Transmission
Chart 8. New HIV/AIDS Cases Among Males
by Mode of Transmission, Oklahoma 2009
98
0
1000
2000
3000
4000
5000
6000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of cases
Year of Diagnosis
Chart 9. Living HIV and AIDS Cases Diagnosed in
Oklahoma by Year, New Cases vs. Total
Living for 2000‐2009
New Total
Unknown <13 13‐19 20‐29 30‐39 40‐49 50‐59 60+
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Age at Diagnosis
Number of Cases
Chart 10. HIV/AIDS Prevalence in Oklahoma
by Age Group as of 2009
99
0
50
100
150
200
250
300
350
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 11. HIV/AIDS Prevalence in Oklahoma
by Gender, 2009
Male Female
MSM
61%
IDU
8%
MSM/IDU
11%
Hetero
5%
Perinatal
0%
Blood Products
1% Unknown
14%
Chart 12. HIV/AIDS Prevalence Among Males
by Mode of Transmission, Oklahoma 2009
100
13‐19
6%
20‐29
33%
30‐39
30%
40‐49
20%
50‐59
10%
60+
1%
Chart 14. New Diagnoses of HIV/AIDS
in Oklahoma, 2009
0
50
100
150
200
250
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 13. HIV and AIDS Cases Diagnosed
in Oklahoma by Year, 1999 ‐2009
HIV cases AIDS cases
101
0
20
40
60
80
100
120
140
160
White Black Hispanic Asian/Pacific
Islander
AI/AN Multi‐Race
Number of Cases
Race/Ethnicity
Chart 15. New HIV/AIDS Cases by
Race and Gender, Oklahoma 2009
Male Female
0 25 50 75 100 125 150
MSM
IDU
MSM/IDU
Hetero
Unknown
Number of Cases Mode of Transmission
Chart 16. New HIV/AIDS Cases by Mode of Transmission
and Gender, Oklahoma 2009
Female Male
102
0
10
20
30
40
50
60
70
80
90
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 18. HIV/AIDS Cases Among Men Who Have Sex
with Men by Age Group, Oklahoma 2000‐2009
13 ‐ 19 yrs
20 ‐ 24 yrs
25 ‐ 29 yrs
30 ‐ 39 yrs
40 ‐ 49 yrs
50 ‐ 59 yrs
60 and over
* Includes MSM and MSM & IDU
0
20
40
60
80
100
120
140
160
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 17. HIV/AIDS Cases by Diagnosis Year for Men
Who Have Sex with Men*, Oklahoma 2000‐2009
AIDS
HIV
* Includes MSM and MSM & IDU
103
0
20
40
60
80
100
120
140
White Black Hispanic AI/AN Multi
Number of Cases
Race/Ethnicity
Chart 19. HIV/AIDS Cases Among Men Who Have Sex
With Men by Race/Ethnicity, Oklahoma 2000‐2009
2009
2004
2000
* Includes MSM and MSM & IDU
0
10
20
30
40
50
60
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases Year of Diagnosis
Chart 20. HIV/AIDS Cases by Diagnosis Year for
Injection Drug Users*, Oklahoma 2000‐2009
* Includes IDU and MSM & IDU IDU MSM & IDU
104
Unknown <13 13‐19 20‐29 30‐39 40‐49 50‐59 60+
0
100
200
300
400
500
600
700
800
900
Age at Diagnosis
Number of Cases
Chart 21. Cumulative HIV/AIDS Cases Among IDU*
By Age Group, Oklahoma 2009
*Includes IDU and MSM & IDU
0
10
20
30
40
50
60
70
80
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 22. HIV/AIDS Cases Among Injection Drug Users*
by Year and Gender, Oklahoma 2009
*Includes IDU and MSM & IDU Male Female
105
White
69%
Black
17%
Hispanic
7%
AI/AN
7%
Chart 23. New HIV/AIDS Cases Diagnosed Among
Injection Drug Users*, Oklahoma 2009
*Includes IDU and MSM & IDU
0
5
10
15
20
25
30
35
40
45
50
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases Year of Diagnosis
Chart 24. HIV/AIDS Cases by Diagnosis Year for
Females*, Oklahoma 2000‐2009
AIDS HIV
* Females Age 13 and Above
106
13‐19 20‐29 30‐39 40‐49 50‐59 60+
0
50
100
150
200
250
300
350
400
450
Age at Diagnosis
Number of Cases
Chart 25. Cumulative HIV/AIDS Cases Among Females*
By Age Group, Oklahoma 2009
*Females age 13 and above AIDS HIV
White
39%
Black
42%
Hispanic
7%
AI/AN
10%
Asian/PI
2%
Chart 26. New HIV/AIDS Cases Diagnosed Among
Females by Race/Ethnicity,* Oklahoma 2009
*Females age 13 and above
107
0
200
400
600
800
1000
1200
1400
1600
1996 2000 2006 2007 2008 2009
Number of Clients
Fiscal Year
Chart 27. Total Clients Served in Oklahoma by
Fiscal Year and Program
Insurance Assistance Co‐Pay Assistance Total HDAP
0
100
200
300
400
500
600
700
800
900
1000
1996 2000 2006 2007 2008 2009
Clients Served
Fiscal Year
Chart 28. Average Clients Served in Oklahoma Per
Month by Fiscal Year and Program
Insurance Assistance Co‐Pay Assistance HDAP
108
0
200
400
600
800
1000
1200
1996 2000 2006 2007 2008 2009
Number of Clients
Fiscal Year
Chart 29. Average Cost Per Client by Fiscal Year
and Program, Oklahoma
Insurance Assistance Co‐Pay Assistance HDAP
53%
78%
89%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<1 1 to 2 3 or more
% Undetectable Years on Regimen
Chart 30. Percent of Clients with Undectable Viral Loads by
Length of Time on ART Regimen, FY09
109
0
50
100
150
200
250
300
350
400
450
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate per 100,0000 population
Year of Diagnosis
Chart 31. Rates of Chlamydia for
Oklahoma vs. United States, 2000‐2009
U.S Oklahoma
0
2,000
4,000
6,000
8,000
10,000
12,000
2000 2001 2002 2003 2004 2005 2006 2007 *2008 *2009
Numbre of Cases
Year of Diagnosis
Chart 32. Reported Chlamydia Cases in Oklahoma
by Gender, 2000‐2009
*Reports available electronically Male Female
110
0
1000
2000
3000
4000
5000
6000
7000
White Hispanic Black Asian/PI AI/AN
Number of Cases
Race/Ethnicity
Chart 33. Chlamydia Cases by Race/Ethnicity,
Oklahoma 2009
0
20
40
60
80
100
120
140
160
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate per 100,000 Population
Year of Diagnosis
Chart 34. Gonorrhea Rates per 100,000 Population,
Oklahoma vs. U.S. 2000‐2009
U.S Oklahoma
111
0 200 400 600 800 1000 1200
AI/AN
Black
White
Asian/PI
Multi
Hispanic
State Total
Rates per 100,000 population
Race/Ethnicity
Chart 36. Reported Gonorrhea Rates per 100,000
population by Race/Ethnicity, Oklahoma 2008‐2009
2008 RATE /100,000 2009 RATE /100,000
0
100
200
300
400
500
600
700
10‐14 15‐19 20‐24 25‐29 30‐34 35‐39 40‐44 45‐49
Rate
Age Group
Chart 35. Reported Gonorrhea by Age Group,
Oklahoma 2008‐2009
2009 RATE /100,000 2008 RATE /100,000
112
0
500
1,000
1,500
2,000
2,500
3,000
3,500
2000 2001 2002 2003 2004 2005 2006 2007 *2008 *2009
Number of Cases Year of Diagnosis
Chart 38. Reported Gonorrhea Cases in Oklahoma
by Gender, 2000‐2009
*Reports available electronically Male Female
0
1
2
3
4
5
6
7
8
9
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate per 100,000 Population
Year of Diagnosis
Chart 37. Early Syphilis Rates per 100,000 Population,
Oklahoma vs. U.S. 2000‐2009
U.S Oklahoma
*US Data for 2009 not available as time of this report.
**Early Syphilis is defined as primary, secondary,
and early latent syphilis.
113
0
5
10
15
20
25
15‐19 20‐24 25‐29 30‐34 35‐39 40‐44 45‐49 50+
Rate
Age Group
Chart 40. Reported Early Syphilis* by Age Group,
Oklahoma 2008‐2009
2009 RATE /100,000 2008 RATE /100,000
*Early Syphilis includes Primary, Secondary, and Early Latent Syphilis.
0
5
10
15
20
25
30
35
40
45
AI/AN Black White Hispanic
Rate per 100,000
Race
Chart 39. Early Syphilis Rate per 100,000 Population
by Race and Ethnicity, Oklahoma 2008‐2009
2009 Rate 2008 Rate
114
0
2
4
6
8
10
12
14
White Black Hispanic AI/AN Multi
Number of Cases
Race/Ethnicity
Chart 41. HIV/AIDS ans Syphilis Co‐morbidity Cases by
Race and HIV Diagnosis, Oklahoma 2000‐2009
*AI/AN ‐ American Indian/Alaska Native AIDS HIV
White
74%
AI/AN
15%
Unknown
11%
Chart 42. Confirmed Acute Hepatitis C Cases
In Oklahoma for 2009
115
Acute Hep B
6%
Chronic Hep B
19%
Hep C
75%
Chart 43. HIV/AIDS Cases Newly Diganosed with
Hepatitis B or C, Oklahoma 2009
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
132
Oklahoma State Department of Health
HIV/STD Service
1000 NE 10th Street
Oklahoma City, OK 73117-1299
405.271.4636
www.ok.gov/health

2009 OKLAHOMA HIV/STD COMPREHENSIVE EPIDEMIOLOGIC PROFILE
To obtain a free copy of this report or to request additional HIV/STD data, please contact:
Oklahoma State Department of Health
HIV/STD Service
1000 NE 10th, MS 0308
Oklahoma City, OK 73117
Phone: (405) 271‐4636
Fax: (405) 271‐1187
Service Chief: Jan Fox, MPH, RN
The Oklahoma State Department of Health (OSDH) is an Equal Opportunity Employer. This publication,
printed by the OSDH, was issued by the OSDH as authorized by Terry Cline, PH.D., Commissioner of
Health. 150 copies were printed in January 2011 at a cost of $3,070.50. Copies have been deposited with
the Publications Clearinghouse of the Oklahoma State Department of Libraries.
CONTRIBUTING AUTHORS:
Terrainia Harris, MPH
Manager of Surveillance and Analysis Office
Sam Nimo, MPH
Epidemiologist
Martin Lansdale, MPH
Epidemiologist
Kristen Eberly, MPH
Director of Prevention and Intervention
Brittney Wigley, MS
Manager of Prevention Quality Assurance and Analysis
Nicole Diehl, MA
Manager, Care QA and Data Analysis
Janet Wilson, RN, MPH
Adult Viral Hepatitis Prevention Coordinator
Ayesha Lampkins, MPH, CHES
Oklahoma City Frontline Disease Intervention Supervisor
EDITORS:
Terrainia Harris, MPH
Olivia Scott
Brittney Wigley, MS
Kristen Eberly, MPH
Sally Bouse‐Pittser, MPH, CHES
Raymond Dallas, MPH, CHES
Debbie Purton, RN, MPH
Lynne Davis
Sam Nimo, MPH
Nicole Diehl, MA
Cover Art Design: Olivia Scott
The HIV/STD Service Surveillance and Analysis Office would like to acknowledge those programs that have
provided data for this document, as well as persons who have helped organize, review, and edit this document.
The collaboration between the HIV/STD Service Prevention and Intervention Division, HIV/STD Service Care and
Delivery Division, and HIV/STD Viral Hepatitis Office has strengthened this publication for our state.
INTRODUCTION
Executive Summary 1
Commonly Used Epidemiologic Terms 3
SECTION 1 8
Oklahoma Population and Demographics 9
SECTION 2 14
Cumulative HIV/AIDS Cases in Oklahoma 15
Living HIV/AIDS Cases in Oklahoma 19
New HIV/AIDS Cases in Oklahoma for 2009 23
SECTION 3 28
Men Who Have Sex with Men 29
Injection Drug Users 33
Females Age 13 and Above 37
SECTION 4 42
Ryan White Care Services in Oklahoma 43
HIV Prevention in Oklahoma 47
HIV Counseling, Testing, and Referral Services 49
SECTION 5 52
Unmet Need in Oklahoma 53
SECTION 6 56
Chlamydia in Oklahoma 57
Gonorrhea in Oklahoma 61
Antibiotic Resistant Gonorrhea 65
Syphilis in Oklahoma 67
Syphilis Outbreak Among Teens 71
HIV and Syphilis Co‐infection 73
Hepatitis B in Oklahoma 75
Hepatitis C in Oklahoma 77
HIV and Hepatitis Co‐Infection 79
TABLES, CHARTS, and GRAPHS 82
MAPS 118
HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immune
Deficiency Syndrome). AIDS is the result of a HIV infection; the term AIDS applies to
the most advanced stage of HIV infection. In Oklahoma, AIDS as a syndrome,
became reportable in 1983 and HIV infection in 1988.
HIV damages a person’s body by destroying specific blood cells, called CD4 positive T‐lymphocytes
(CD4+ T cells), which are crucial to helping the body fight diseases.
People living with HIV may appear and feel healthy for several years, while HIV is still
affecting their bodies.
AIDS is defined as having HIV with fewer than 200 CD4+ T cells per cubic milliliter of
blood, and/or any one of 26 clinical opportunistic conditions which affect those with
compromised immune systems. Before the development of highly active
antiretroviral therapy (HAART), people with HIV often progressed to AIDS in just a
few years. Currently, people are living much longer ‐ even decades ‐ with HIV before
developing AIDS.
At the end of 2009, an estimated 8,181 cases of HIV/AIDS had been diagnosed in
residents of Oklahoma, 5,335 AIDS and 2,846 HIV. Of these cases, 5,320 (65%) were
diagnosed among Whites; 1,703 (20.8%) among Black/African Americans; 469 (5.7%)
among Hispanics; 42 (0.5%) among Asian/Hawaiian Pacific Islanders; and 522 (6.4%)
among American Indian/Alaskan Natives. Persons who reportedly belonged to two or
more races accounted for 125 (1.5%) of the cases diagnosed. By the end of 2009,
3,257 cases were known to have died.
The ratio of males to females diagnosed was 6:1 (6,981, 85.3% to 1,200, 14.7%)
respectively. Those reporting a risk of males having sex with males (MSM)
represented 52.7% (4,311) of cases, while MSM and intravenous drug use
(MSM/IDU) represented 10.5% (857). Over 11% reported a risk of intravenous drug
use (IDU). About 11.2% (919) were exposed via heterosexual contact.
Among age groups, ages 30‐39 years accounted for the largest proportion of cases
(38.5%; 3,151), followed by 20‐29 years with 31.3% (2,563). Teenagers 13‐19 years of
age accounted for a total of 2.7% (217) of cases, while children under the age of 13
years accounted for 0.8% (64) of the 8,181 cases.
In 2009, 312 cases of HIV/AIDS were diagnosed in Oklahoma. This was a 9%
decrease in the number of cases diagnosed since 2008. Although there was
approximately a 26% decrease in the number of newly diagnosed AIDS cases from
1999 to 2009, there has been a 49% increase in the number of newly diagnosed HIV
cases.
AIDS was first
reported in the
United States in
1981.
In Oklahoma, two
cases of AIDS
were first
diagnosed in
1982 and two
cases of HIV in
1984.
1
HIV/STD Service
Oklahoma State
Department of Health
Of the 312 cases diagnosed, males reported 255 cases with a rate of 14.2 per
100,000 population, while females reported 57 cases with a rate of 3.1 per 100,000
population. During 2009, three counties in Oklahoma accounted for about 61% of
the cases—Oklahoma, Tulsa, and Cleveland counties with 32.7% (102), 21.8% (68),
and 6.4% (20) respectively.
Of the 312 cases, 136 (43.6%) reported their risk as MSM and 11 (3.5%) reported
their risk as MSM/IDU. Eighteen (5.8%) persons reported their risk as IDU only.
Forty‐four (14.1%) persons were infected through heterosexual contact. More than
one quarter of those diagnosed in 2009 did not report a risk.
2
Following is a list of definitions and commonly used epidemiologic terms.1
Note: the numbers given in the examples are for illustrative purposes only.
AIDS: (acquired immunodeficiency syndrome): An HIV‐infected person receives a
diagnosis of AIDS after the development of one of the CDC‐defined AIDS indicator
illnesses (see opportunistic infection) or on the basis of the results of specific blood tests
(i.e., a CD4+ count of less than 200 cells/microliter or a CD4+ percentage of less than 14).
A positive HIV test result does not mean that a person has AIDS.
Case: A condition, such as HIV infection (e.g., an HIV case) or AIDS (e.g., an AIDS case)
diagnosed according to a standard case definition.
Cumulative Cases: The total number of cases of a disease reported or diagnosed during a
specified time. Cumulative cases can include cases in people who have died.
Denominator: Divisor; the term of a fraction, usually written under or after the line that
indicates the number of equal parts into which the unit is divided; used to calculate a rate
or ratio. For example, in the fraction ¾, four is the denominator.
Epidemiology: The study of the distribution and determinants of health‐related states or
events in specified populations, and the application of this study to control health
problems.
Exposure: Contact with a source of a disease agent in such a manner that effective
transmission of agent may occur.
Exposure Category: The exposure mode indicates which risk behavior had the highest
probability of being the route of infection. For surveillance purposes, HIV infection cases
and AIDS cases are counted only once in a hierarchy of exposure modes. The hierarchy
was developed by CDC to predict the most likely cause of infection when a person has
engaged in multiple risky behaviors. Note that the hierarchy is based on the likelihood of
transmission given a single instance of the risky behavior, and any occurrence of the
behavior since 1978 counts. The hierarchy has been criticized because how often or how
recently people have put themselves at risk (or been put at risk) are not taken into
account. Some exposure modes, such as Pediatric and Blood/Blood Products are not risk
behaviors on the part of the infected individuals.
Persons with more than one reported mode of exposure to HIV are classified in the
exposure category listed first in the hierarchy, except for men with both a history of
sexual contact with other men and injection drug use. They make up a separate
exposure category.
CDC
Centers for
Disease Control
and Prevention
HRSA
Health Resources
and Services
Administration
ACRF
Adult Case
Report Form
DIS
Disease
Intervention
Specialist
1Last, John M. A Dictionary of Epidemiology. 4th Ed. New York: Oxford University Press, Inc., 2001.; Centers for Disease Control
and Prevention and Health Resources and Services Administration. Integrated Guidelines for Developing Epidemiologic Profiles: HIV
Prevention and Ryan White CARE Act Community Planning. Atlanta, Georgia: Centers for Disease Control and Prevention; 2004.
3
HIV/STD Service
Oklahoma State
Department of Health
Following is a description of the Exposure Mode categories in the hierarchical order:
 MSM (Male to Male Sex): Includes men who report sexual contact with other
men, and men who report sexual contact with both men and women.
 IDU (Injection Drug Use): Cases in persons who report injection drug use.
 MSM & IDU: Cases in men who report both injection drug use and sexual contact
with other men.
 Heterosexual Sex: Cases in persons who report specific heterosexual sex with a
person with, or at increased risk for, HIV infection (e.g. an injection drug user).
 Pediatric: Infection before the age of 13, including mother to child transmission
through pregnancy, childbirth, or breastfeeding, and blood transfusions to
children.
 No Identified Risk: Cases in persons with no reported history or unknown history
of exposure to HIV through any of the listed exposure categories.
HIV: Human Immunodeficiency Virus (HIV) is the virus which causes AIDS. HIV is a virus
that kills the body’s CD4 cells. CD4 cells help a body fight off infection and disease.
Incidence: The number of new cases in a defined population during a specific period,
often a year, which can be used to measure disease frequency. It is important to
understand the difference between HIV incidence and reported HIV diagnoses. While
trends in HIV diagnosis are our best indicator for who is most at risk for HIV infection, HIV
surveillance reflects the incidence of diagnoses among people who are in care and not the
actual incidence of new infections. Like AIDS diagnoses, HIV diagnoses are not a direct
measure of incidence of infection itself. People may be infected with the virus for many
years prior to being tested and seeking care, at which point the case is considered a
“diagnosis” and reported to the Oklahoma State Department of Health HIV/AIDS
Surveillance system.
Incidence Rate: The number of instances (new cases) of illness commencing, or persons
falling ill, during a given period in a specified population. Incidence rate is calculated by
dividing incidence during a specified period of time by the population in which cases
occurred. A multiplier is used to convert the resulting fraction to a number over a
common denominator (often 100,000).
Morbidity: The presence of illness in the population.
Mortality: The total number of persons who have died of the disease of interest, usually
expressed as a rate. Mortality (total number of deaths over the total population)
measures the effect of the disease on the population as a whole.
4
Mortality (Death) Rate: An estimate of the portion of a population that dies during a
specified period of time.
No Identified Risk (NIR): Cases in which epidemiologic follow‐up has been conducted and
sources of data have been reviewed, which may include an interview with the patient or
provider, and no mode of exposure has been identified. Any case that continues to have
no reported risk for 12 or more months after the report date is considered NIR.
Numerator: Dividend, the term of a fraction, usually written above or before the line that
indicates the number of parts that are to be divided, used to calculate a rate or ratio. For
example, in the fraction ¾, three is the numerator.
People Living with HIV/AIDS: Includes all persons not known to be dead and who have
ever been diagnosed with HIV infection and/or AIDS, regardless of their current clinical
status. Only people who have been reported to the Oklahoma State Department of
Health HIV/AIDS Surveillance system are included in counts.
Percent Increase or Decrease: The rate of change between one time period and another
earlier time period. For example, if 60 AIDS cases were diagnosed in 1992 and 80 were
diagnosed in 1995, the calculation looks like this:
80 – 60 = 20 20 ÷ 60 = 0.33 0.33 X 100 = 33%
Therefore, the number of cases increased 33% from 1992 to 1995.
Note: You can have large percentage increases but you can never have a decrease of over
100%.
Perinatal Transmission: HIV transmission from mother to child during pregnancy, labor
and delivery, or breastfeeding.
Prevalence: The number of instances of a given disease or condition, in a given
population at a designated time (e.g. the number of total living HIV).
Proportion/Percentage: A type of ratio in which the numerator is included in the
denominator. The ratio of a part to a whole, expressed as a decimal fraction (e.g. 0.2), as
a vulgar fraction (e.g. 1/5), or as a percentage (e.g. 20%).
Rate: A measure of the frequency of occurrence of a phenomenon. The use of rates
rather than raw numbers is essential for comparison of experiences between populations
at different times, different places, or among different classes of persons. The
components of a rate are the numerator, the denominator, the specified time in which
events occur, and a multiplier (usually a power of 10).
Rate 􀵌
􀜰􀝑􀝉􀜾􀝁􀝎 􀝋􀝂 􀝁􀝒􀝁􀝊􀝐􀝏 􀝅􀝊 􀜽 􀝏􀝌􀝁􀜿􀝅􀝂􀝅􀝁􀝀 􀝌􀝁􀝎􀝅􀝋􀝀 􀝋􀝂 􀝐􀝅􀝉􀝁
􀜣􀝒􀝁􀝎��􀝃􀝁 􀝌􀝋􀝌􀝑􀝈􀜽􀝐􀝅􀝋􀝊 􀝀􀝑􀝎􀝅􀝊􀝃 􀝌􀝁􀝎􀝅􀝋􀝀 􀝋􀝂 􀝐􀝅􀝉􀝁
􀝔 100,000
HAART
Highly Active
Antiretroviral
Therapy
MSA
Metropolitan
Statistical Area
NRR
No Reported Risk
COPHI
Cases of Public
Health
Importance
5
HIV/STD Service
Oklahoma State
Department of Health
Surveillance: In a public health context, refers to the intentional collection of data on
diseases or other important health conditions in order to monitor where the condition
occurs and to determine the risk factors associated with the condition.
Trend: A long‐term movement or change in frequency, usually upward or downward; may
be presented as a line graph.
Year of diagnosis: The year in which a diagnosis of HIV infection or AIDS was made.
Year of report: The year in which a person with a diagnosis of HIV infection or AIDS was
reported to the health department.
6
7
What are the demographic characteristics
of the general population in Oklahoma?
8
1Population Statistics compiled using the United States Census 2009 American Community Survey 1‐Year Estimates.
Population Statistics1
As of 2009, it was estimated that Oklahoma had a total population of approximately 3.7
million, with 51% (1.9 million) females and 49% (1.8 million) males. Although Oklahoma is
made up of 77 counties, 44% of the population lives in 4 counties: Oklahoma (716,704),
Tulsa (601,961), Cleveland (221,589), and Comanche (113,228). Oklahoma and Tulsa
counties account for 36% of the total population. Oklahoma City (560,226) and Tulsa
(389,369) are the 2 largest cities in the state, followed by Norman (109,056) and Broken
Arrow (101,443).
Race Information
 The majority of Oklahomans reported their race as White (75.4%), followed by
Black/African Americans (7.3%), American Indians and Alaska Natives (6.1%), and
Asians and Hawaiian/Pacific Islanders (less than 2%).
 Seven percent of Oklahomans reported two or more races.
 Seventy‐one percent of Oklahomans were reported as White, Non‐Hispanic.
 Hispanic Oklahomans constituted 8.2% of the population; however, people of Hispanic
origin may be of any race.
Age Information
 The median age in Oklahoma was 35.7 years. More than half (51%) of Oklahomans
were between the ages of 20 and 64.
 Twenty‐five percent of the population was under 18 years and 13 percent was 65 years
and older.
Oklahoma is
ranked 28th for
the largest
population in the
United States.
There are 98
men for every
100 women in
Oklahoma.
Mexican
accounts for
83% of Hispanic
ethnicity in
Oklahoma.
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
White Black American
Indian
Asian/Pacific
Islander
Other Multiple
Race
Number of People
Race Group
Chart 1. Race Distribution of People
in Oklahoma for 2009*
*2009 American Community Survey 1‐Year Estimates
9
HIV/STD Service
Oklahoma State
Department of Health
 Of the Oklahomans age 18 years and older, 49% were male and 51% were female. Of those 65
years and older, 43% were male and 57% were female.
 Age group 15‐24 years constituted 14.7% of the Oklahoma population.
Income Information
 In 2009, there were 1.4 million households in Oklahoma. The average household size was 2.5
people and the average family size was 3.1 people.
 The median household income in Oklahoma was $41,664 with 15% of Oklahomans below the
federal poverty line and 85% at or above the poverty line.
0
100,000
200,000
300,000
400,000
500,000
600,000
0‐9 10‐14 15‐19 20‐24 25‐34 35‐44 45‐54 55‐64 65+
Number of People
Age Group (in years)
Chart 2. Age Distribution of People
in Oklahoma for 2009*
*2009 American Community Survey 1‐Year Estimates
0
50,000
100,000
150,000
200,000
250,000
300,000
Less than
$15K
$15K to
$24K
$25K to
$34K
$35K to
$49K
$50K to
$74K
$75K to
$99K
$100K to
$149K
$150K to
$199K
$200K or
more
Number of People
Annual Income (in Dollars)
Chart 3. Income Distribution of People in
Oklahoma for 2009*
*2009 American Community Survey 1‐Year Estimates
10
 Sixteen percent of all Oklahomans were living in poverty. Of families with a female
head of household and no husband present, 36% had incomes below the poverty
level.
 Fifty‐nine percent of the Oklahoma population were married (15 years or older),
22% were single or had never married, and 12% were divorced (7% are widowed).
 In 2009, of Oklahomans 16 years and older who were employed, the leading
industries were educational services, health care, and social assistance (combined
for 23%), and retail trade (11%).
Education Information
 Eighty‐six percent of Oklahomans age 25 years and older had at least a high school
diploma, while 23% had a bachelor's degree or higher.
 Fourteen percent of adults in Oklahoma were classified as dropouts, which is
defined as not being enrolled in school and having not graduated from high school.
 In 2009, the Oklahoma school enrollment was 968,000. Nursery school and
kindergarten enrollment was 120,000 and elementary through high school
enrollment was 596,000. College through graduate school enrollment was
252,000.
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
9th to 12th
grade, no
diploma
High school
graduate
Some college,
no degree
Associate's
degree
Bachelor's
degree
Graduate or
professional
degree
Number of People
Educational Attainment
Chart 4. Education Distribution of People in
Oklahoma for 2009
*2009 American Community Survey 1‐Year Estimates
3.1% of
Oklahomans
live in a
multigenerational
household.
39% of
Oklahomans have
two vehicles per
household.
19% of
Oklahomans have
no health
insurance (public
or private).
11
12
13
What is the scope of HIV/AIDS
in Oklahoma?
14
Overview
At the end of 2009, an estimated 8,181 cases of HIV/AIDS had been diagnosed
among residents of Oklahoma. A breakdown of these HIV/AIDS cases shows 5,335
AIDS cases and 2,846 HIV cases. An estimated 4,924 cases of HIV/AIDS were living
with the infection; 2,441 (49.6%) AIDS cases and 2,483 HIV cases (50.4%). By 2009,
3,257 cases were known to have died.
By Age Group
Of the total HIV/AIDS cases diagnosed in Oklahoma by age group (age at diagnosis):
 30‐39 year olds accounted for 39% (3,151),
 20‐29 year olds accounted for 31% (2,563),
 40‐49 year olds accounted for 18% (1,512),
 50‐59 year olds accounted for 6% (494),
 Teenagers (13‐19 years) represented 3% (217),
 Age 60 years and above accounted for 2% (163),
 Pediatric cases (12 and under) accounted for 1% (64), and
 17 of the cases did not have an age of diagnosis reported.
In 1982, the first
2 cases of AIDS
were diagnosed
in Oklahoma.
The ratio of
males to females
diagnosed with
HIV/AIDS was
6:1.
74% of
Oklahoma men
diagnosed with
HIV had a risk
factor of MSM or
MSM & IDU.
Unknown
13<
13‐19
20‐29
30‐39
40‐49
50‐59
60+
0 1000 2000 3000 4000
Age at Diagnosis
Number of Cases
Chart 6. Cumulative HIV/AIDS in Oklahoma
as of 2009
0
1000
2000
3000
4000
5000
6000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of cases
Year of Diagnosis
Chart 5. HIV and AIDS Cases Diagnosed in Oklahoma
by Year, Incidence vs. Prevalence for 1999 ‐2009
Incidence Prevalence
15
HIV/STD Service
Oklahoma State
Department of Health
By Gender
Since 2000, males in Oklahoma have seen a 5% increase in the number of cases
diagnosed (from 243 cases to 255), while Oklahoma females have seen an 18%
decrease (from 67 cases to 57).
Among males, Hispanic males had the largest percent increase (108%) from 2000 to
2009 (13 cases to 27 cases).
 Black males had the second largest percent increase in Oklahoma (41%),
from 49 cases to 69 cases.
 American Indian and Alaska Native males had the largest percent decrease
(75%) among all races (21 cases to 12 cases), and
 White males had the second largest percent decrease (13%), from 158 cases
to 140 cases.
 Asian/Pacific Islanders and those with two or more races stayed about the
same from 2000 to 2009.
Among females diagnosed with HIV/AIDS in Oklahoma:
 Black females had a 20% increase in cases between 2000 and 2009 (from 20
cases to 24 cases).
 Hispanic females also had an increase in cases; however, only accounted for
4 cases diagnosed in 2009.
 White females experienced a 50% decrease in cases over the past decade.
 American Indians and Alaska Natives also experienced a decrease (33%) from
8 cases to 6 cases; however, only accounted for 11% of cases in 2009.
 Overall, the number of female cases has been irregular over the past 10
years.
0
50
100
150
200
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 7. New HIV/AIDS Cases Among Males by Race,
Oklahoma 2000‐2009
White
Black
Hispanic
AI/AN
Asian/PI
Multi
16
Since 2000,
HIV/AIDS
diagnoses among
Oklahomans
50‐59 years old
has increased
39%.
HIV Cases among
Hispanics/Latinos
have doubled
over the past
10 years.
Most of the
HIV/AIDS
deaths in 2009
were among
Blacks.
By Race and Ethnicity
Of the cumulative HIV/AIDS cases diagnosed in Oklahoma,
 5,320 (65%) were White,
 1,703 (20.8%) were Black/African American,
 469 (5.7%) were Hispanic,
 42 (0.5%) were Asian/Hawaiian Pacific Islanders, and
 522 (6.4%) were American Indian/Alaskan Native.
 Persons who reported multiple races accounted for 125
(1.5%) of the cases diagnosed.
By Mode of Transmission
Of the cumulative HIV/AIDS cases among children, adolescents, and adults:
 53% (4,311) were classified as men who have sex with men (MSM);
 11% (931) were classified as injection drug use (IDU);
 11% (857) were classified as MSM & IDU;
 10% (804) were classified as heterosexual sex with someone HIV positive;
 2% (136) received blood or blood products;
 Less than 1% were perinatal exposures;
 Less than 0.5% were classified as other confirmed risk; and
 33% (103) were classified as NRR or NIR.
��� 62% of males had a risk of MSM, while 43% of females had a risk or
heterosexual.
Table 4. Cumulative HIV/AIDS Cases Diagnosed in Oklahoma
By Race/Ethnicity and Sex as of 2009
Race/Ethnicity Male Female Total
White 4,680 640 5,320
Black 1,359 344 1,703
Hispanic, All Races 394 75 469
Asian/Pacific Islander 32 10 42
American Indian/Alaska Native 422 100 522
Multiple Races 94 31 125
17
HIV/STD Service
Oklahoma State
Department of Health
HIV/AIDS Deaths
Since 1982, a total of 3,257 Oklahomans diagnosed with HIV/AIDS have died.
 Males accounted for 89% of deaths, and females accounted for 11%.
 Age group1 30‐39 years accounted for 40% of deaths, followed by 20‐29
years (29%), and 40‐49 years (19%).
 72% of deaths were among Whites, followed by Blacks (17%), and American
Indians and Alaska Natives (7%).
Of those Oklahomans who died in 2009:
 All were male.
 The majority were Black (70%), with the remainder being White (30%).
 Most (80%) were ages 40‐59 years.
�� Half (50%) were classified as MSM, 40% were classified as either NRR or NIR,
and 10% were heterosexual contact.
0
1000
2000
3000
4000
5000
Number of Cases
Mode of Transmission
Chart 8. New HIV/AIDS Cases Among Males
by Mode of Transmission, Oklahoma 2009
1Age group based on age at diagnosis.
18
Overview
At the end of 2009, an estimated 4,924 cases of HIV/AIDS had been diagnosed
among residents of Oklahoma with a prevalence rate of 134 per 100,000 population.
Since 2000, there has been a 35% increase in the number of living (prevalent) HIV
cases. Of the 312 HIV/AIDS cases diagnosed in Oklahoma in 2009, 302 were still
living by the end of 2009.
By Age Group
The age group breakdown of living HIV/AIDS cases diagnosed in Oklahoma was
similar to the breakdown of cumulative cases (age at diagnosis):
 30‐39 year olds accounted for 37.7% (1,860),
 20‐29 year olds accounted for 33% (1,620),
 40‐49 year olds accounted for 18.3% (900),
 50‐59 year olds accounted for 5.5% (271),
 Teenagers (13‐19 years) represented 3.6% (175),
 Age 60 years and above and Pediatric cases (12 and under)
accounted for less than 2% (87), and
 11 of the cases did not have an age of diagnosis reported.
Since 2000, most age groups have seen an increase in the number of living HIV/AIDS
cases diagnosed each year.
 There has been a 100% increase in the number of living HIV/AIDS cases
diagnosed among persons 13‐19 years (from 9 cases to 18 cases).
 Persons 20‐29 years of age had a 75% increase over the past ten years, from
59 cases to 103 cases.
2,441 living
AIDS cases and
2,483 living HIV
cases were
diagnosed in
Oklahoma as of
2009.
There are 5 men
for every woman
living in
Oklahoma with
HIV.
20‐39 year olds
account for 70%
of cases.
0
1000
2000
3000
4000
5000
6000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 9. Living HIV and AIDS Cases Diagnosed in
Oklahoma by Year,
New Cases vs. Total Living for 2000‐2009
New Total
19
HIV/STD Service
Oklahoma State
Department of Health
By Gender
As of 2009, males diagnosed in Oklahoma accounted for 83% of living HIV/AIDS cases
at a rate of 224 per 100,000 population. In comparison, females accounted for 17%
of cases at a rate of 45 per 100,000. In 2000, the prevalence rate for males was
113.5 per 100,000 population and for females it was 20 per 100,000 population.
Among females diagnosed in Oklahoma and living with HIV/AIDS:
 Black females had a 100% increase in cases between 2000 and 2009 (from 12
cases to 24 cases).
 Hispanic females also had an increase in cases; however, only accounted for
4 cases diagnosed in 2009.
 All other races stayed about the same.
Unknown <13 13‐19 20‐29 30‐39 40‐49 50‐59 60+
0
500
1000
1500
2000
Age at Diagnosis
Number of Cases
Chart 10. HIV/AIDS Prevalence in Oklahoma
by Age Group as of 2009
0
100
200
300
400
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 11. HIV/AIDS Prevalence in Oklahoma
by Gender, 2009
Male Female
20
The prevalence
rate among
Blacks is 4
times higher
than Whites.
Since 2000,
cases among
Hispanics
increased 139%.
Since 2000,
heterosexual
cases have
increased 44%.
Among males, except for American Indian and Alaska Native males, all races saw
some type of increase from 2000 to 2009.
 Hispanic males had the largest percent increase (125% increase) from 2000
to 2009 (12 cases to 27 cases).
 Black males had the second largest percent increase in Oklahoma (77%),
from 35 cases to 62 cases.
 White males had the third largest percent increase (17%), from 117 cases to
137 cases.
 American Indian and Alaska Native males had the largest percent decrease
(25%) among all races (16 cases to 12 cases).
By Race and Ethnicity
Of persons living with HIV/AIDS and diagnosed in Oklahoma at the end of 2009,
 Whites had a rate of 107 per 100,000 population.
 Blacks had a rate of 428 per 100,000 population, more than three times
higher than the state rate. Since 2000, Blacks have had an 83% increase in
the number of cases.
 Hispanics had a rate of 119 per 100,000 population.
 Asian/Pacific Islanders had a rate of 52 per 100,000 population.
 American Indian/Alaskan Natives had a prevalence rate of 138 per 100,000
population.
 19 per 100,000 population was the prevalence rate for persons who
reported multiple races.
Table 5. Living HIV/AIDS Cases Diagnosed in Oklahoma
By Race/Ethnicity as of 2009
Race/Ethnicity AIDS HIV Total
White 1,476 1,497 2,973
Black 534 616 1,150
Hispanic, All Races 186 172 358
Asian/Pacific Islander 16 17 33
American Indian/Alaska Native 177 131 308
Multiple Races 52 50 102
21
HIV/STD Service
Oklahoma State
Department of Health
By Mode of Transmission
Of the living HIV/AIDS cases among children, adolescents, and adults:
 50% (2,470) were classified as men who have sex with men (MSM);
 11% (525) were classified as injection drug use (IDU);
 9% (455) were classified as MSM & IDU;
 12% (579) were classified as heterosexual sex with someone HIV positive;
 Less than 1% (41) received blood or blood products;
 Less than 1% (29) were perinatal exposures; and
 17% (825) were classified as NRR or NIR.
Geographic Distribution in Oklahoma
 Five counties in Oklahoma accounted for 76% of the living HIV (Not AIDS) cases
diagnosed in Oklahoma: Oklahoma (955), Tulsa (637), Cleveland (160),
Comanche (143), and Canadian (47).
 The top five counties with the highest prevalence of HIV (Not AIDS) cases are as
follows:
1. Oklahoma County ‐ 135 per 100,000 population
2. Comanche County ‐ 127 per 100,000 population
3. Tulsa County ‐ 108 per 100,000 population
4. Caddo County ‐ 89 per 100,000 population
5. Blaine County ‐ 79 per 100,000 population
MSM
IDU 61%
8%
MSM/IDU
11%
Hetero
5%
Perinatal
0%
Blood Products
1%
Unknown
14%
Chart 12. HIV/AIDS Prevalence Among Males
by Mode of Transmission, Oklahoma 2009
1Age group based on age at diagnosis. 22
Overview
In 2009, 312 cases of HIV/AIDS were diagnosed in Oklahoma. This was a 9% decrease in
the number of cases diagnosed in 2008. From 1999 to 2009 (11 years), 3,614 cases of
HIV/AIDS were diagnosed at an average of 329 cases per year, with an average rate of 9.1
cases per 100,000 population per year. Although there was approximately a 26% decrease
in the number of newly diagnosed AIDS cases between 1999 and 2009, there was a 49%
increase in the number of newly diagnosed HIV cases.
Of the 312 cases diagnosed,
 255 cases were among males (with a rate of 14 per 100,000 population); and
 57 cases were among females (with a rate of 3.1 per 100,000 population).
During 2009, three counties in Oklahoma accounted for about 61% of the cases:
 Oklahoma 32.7% (102),
 Tulsa 21.8% (68), and
 Cleveland 6.4% (20).
By Age Group
Of the total HIV/AIDS cases diagnosed in 2009 by age group:
 20‐29 year accounted for 33% (104),
 30‐39 years accounted for 30% (92),
 40‐49 years accounted for 20% (62),
 50‐59 year accounted for 10% (32),
 Teenagers (13‐19 years) represented 6% (18), and
 Age 60 years and above accounted for 1% (4).
0
50
100
150
200
250
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 13. HIV and AIDS Cases Diagnosed in
Oklahoma by Year, 1999‐2009
HIV cases AIDS cases
Oklahoma is
ranked 29th for
the largest
number of new
diagnoses of HIV.
In 2009, there
were 180 HIV
and 132 AIDS
cases diagnosed
in Oklahoma.
Oklahoma had a
total of 312 new
HIV/AIDS cases in
2009, and 342 in
2008.
23
HIV/STD Service
Oklahoma State
Department of Health
13‐19
6%
20‐29
33%
30‐39
30%
40‐49
20%
50‐59
10%
60+
1%
Chart 14. New Diagnoses of HIV/AIDS in
Oklahoma, 2009
By Race and Ethnicity
 Among racial and ethnic groups, Blacks/African Americans (31.3 cases per 100,000
population) had the highest rate of new HIV/AIDS cases for 2009. Their rate was
almost four times the rate for the entire state.
 Hispanics (10.3 cases per 100,000 population) had the second highest rate for new
HIV/AIDS cases in Oklahoma for 2009. The rate for Hispanics was 1.2 times higher than
the state rate.
 Asian/Pacific Islanders had a rate of 7.5 per 100,000 population,
 American Indians /Alaskan Natives had a rate of 6.1 cases per 100,000 population, and
 Whites had a rate of 5.6 cases per 100,000 population.
24
Since 2000, the
number of cases
among teens
has almost
doubled.
Since 2000, there
has been as
135% increase
among ages 20‐
29 years.
The rate of new
HIV/AIDS cases
among black
males is 47 per
100,000
population.
By Mode of Transmission
Of the 312 cases who reported their risk,
 43.6% (136) were classified as men who have sex with men (MSM),
 14.1% (44) were classified as heterosexual sex with someone HIV positive,
 5.8% (18) were classified as injection drug use (IDU),
 3.5% (11) were classified as MSM and IDU, and
 33% (103) were classified as no reported risk or no identified risk.
0 25 50 75 100 125 150
MSM
IDU
MSM/IDU
Hetero
Unknown
Number of Cases
Mode of Transmission
Chart 16. New HIV/AIDS Cases by Mode of
Transmission and Gender, Oklahoma 2009
Female Male
0
20
40
60
80
100
120
140
160
White Black Hispanic Asian/Pacific
Islander
AI/AN Multi‐Race
Number of Cases
Race/Ethnicity
Chart 15. New HIV/AIDS Cases by Race and Gender,
Oklahoma 2009
Male
Female
25
HIV/STD Service
Oklahoma State
Department of Health
Geographic Distribution
Of those newly diagnosed in 2009, the top five zip codes in the Oklahoma City and Tulsa
areas are as follows (in order of largest number of cases):
1. 73107
2. 73112
3. 73106 and 73105
4. 74105 and 73118
5. 74137 and 73109
Table 6. Top Five Counties of Newly Diagnosed HIV/AIDS Cases
in Oklahoma for 2009
By Number of Cases By Rate per 100,000
1 Oklahoma Osage
2 Tulsa Hughes
3 Cleveland Logan
4 Osage Oklahoma
5 Canadian Tulsa
*Counties with fewer than 3 cases were removed from the analysis for confidentiality reasons.
26
27
What are the indicators of risk for HIV
infection and AIDS in Oklahoma?
28
MSM AIDS cases
have decreased
69% since 2000.
HIV cases among
MSM and MSM &
IDU have
increased 42%.
73% of all males
diagnosed in
Oklahoma had an
exposure of MSM
or MSM & IDU.
Overview
Of the 4,924 persons living with HIV/AIDS at the end of 2009, more than half (60%)
reported a mode of transmission of MSM or MSM & IDU. Of all the males living with
HIV/AIDS, 72% reported their risk as MSM or MSM & IDU, and 61% reported a risk of MSM
only. Since 1982, a total 5,168 HIV/AIDS cases have reported a risk of MSM or MSM & IDU.
Of new HIV cases (180) diagnosed in Oklahoma in 2009, MSM accounted for 76% of cases,
while MSM & IDU accounted for 6%. Although MSM transmission has decreased 55%
among new AIDS cases since 2000, it has increased 54% among new HIV cases.
 Of the 8,181 cumulative cases diagnosed in Oklahoma (regardless of transmission), 63%
were among males who identified themselves as MSM or MSM & IDU.
 In 2009, 47% of all cases diagnosed in Oklahoma were among MSM or MSM & IDU.
 Of the 2,925 MSM and MSM & IDU living with HIV/AIDS at the end of 2009, 84% were
MSM and 16% were MSM & IDU.
By Age Group
 Of the cumulative cases diagnosed in Oklahoma, 30‐39 years comprised the largest
proportion (41%), followed by 20‐29 years (34%) and 40‐49 years (17%).
 In 2009, 38% of HIV/AIDS cases were diagnosed among age group 20‐29 years, followed
by 30‐39 years (27%), and 40‐49 years (17%).
0
50
100
150
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 17. HIV/AIDS Cases by Diagnosis Year for Men
Who Have Sex with Men*, Oklahoma 2000‐2009
AIDS
HIV
* Includes MSM and MSM & IDU
29
HIV/STD Service
Oklahoma State
Department of Health
 Of gay and bisexual males living with HIV/AIDS as of December 2009, 42% had a current
age of 40‐49 years, followed by 24% who were age 50‐59 years, and 20% being 30‐39
years of age.
 Since 2000, there has been an 80% increase in HIV cases among ages 20‐24 years and a
38% increase among those 25‐29 years.
 Age group 30‐39 years has had a decrease in both HIV (33% decrease) and AIDS (63%
decrease) over the past 10 years.
 Age group 50‐59 years has had a 100% increase in HIV cases with 4 cases in 2000 and 8
cases in 2009.
By Race/Ethnicity
 Of all cases diagnosed in Oklahoma, Black males accounted for 17% of gay and bi‐sexual
males diagnosed with HIV/AIDS. Black males account for 3.6% of Oklahomans.
 American Indian/Alaska Native males comprised 6% of cases diagnosed in Oklahoma,
however, account for only 2.9% of the population.
 In 2009, Black males represented 17% of MSM and MSM & IDU cases, followed by
American Indian and Alaska Native males (6%), and Hispanic males (4%).
 Over the past 10 years, White males had a 47% decrease in the number of AIDS cases
and a 58% increase in the number of HIV cases.
0
10
20
30
40
50
60
70
80
90
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 18. HIV/AIDS Cases Among Men Who Have
Sex with Men by Age Group, Oklahoma 2000‐2009
13 ‐ 19 yrs
20 ‐ 24 yrs
25 ‐ 29 yrs
30 ‐ 39 yrs
40 ‐ 49 yrs
50 ‐ 59 yrs
60 and
over
* Includes MSM and MSM & IDU
30
Since 2000, there
has been a
150% increase
of HIV cases
among those age
13‐19 years.
In 2009, White
males accounted
for 71% of MSM
cases and
comprised only
37% of the
Oklahoma
population.
 Of gay and bisexual males living with HIV/AIDS in Oklahoma at the end of 2009,
o 67% were White,
o 19% were Black,
o 6% were American Indian or Alaska Native,
o 5.5% were Hispanic, and
o 2% had Multiple Races.
 Since 2009, Black males have had a 26% decrease in AIDS cases and a 20% increase in
HIV cases.
 Hispanic males have had a 66% increase in AIDS cases since 2000, and a 33% increase in
HIV cases.
 American Indian and Alaska Native males have experienced a 266% decrease in the
number of AIDS cases (from 11 cases to 3 cases), however a 33% increase among HIV.
By Geographic Distribution
 Of the new MSM cases diagnosed in 2009,the top five counties with the largest number
of cases were as follows:
1. Oklahoma
2. Tulsa
3. Osage
4. Cleveland and Canadian
5. Creek and Logan
 The top three zip codes with the largest number of new MSM diagnoses in the
Oklahoma City and Tulsa areas were as follows: 73112, 74105, and 73106.
0
20
40
60
80
100
120
140
White Black Hispanic AI/AN Multi
Number of Cases
Race/Ethnicity
Chart 19. HIV/AIDS Cases Among Men Who Have Sex
With Men by Race/Ethnicity, Oklahoma 2000‐2009
2009
2004
2000
* Includes MSM and MSM & IDU
31
32
Overview
By the end of 2009, 1,788 Oklahomans diagnosed with HIV/AIDS reported a risk of
either IDU or MSM & IDU. A total of 931 were classified as IDU only. Of the 4,924
Oklahomans living with HIV/AIDS, 11% (525) were classified as IDU, and 9% (455)
were classified as MSM & IDU.
Of new HIV/AIDS cases (312) diagnosed in Oklahoma in 2009, IDU accounted for 6%
of cases, while MSM & IDU accounted for 4% (a combined total of 9.3%). IDU
transmission has decreased drastically over the past decade. In 2000, IDU and MSM
& IDU accounted for 18% of new HIV/AIDS cases and 24% of total cases diagnosed in
Oklahoma.
By Age Group
The age group breakdown of IDU and MSM & IDU HIV/AIDS cases diagnosed in
Oklahoma are as follows:
 30‐39 year olds accounted for 43% (768),
 20‐29 year olds accounted for 32% (570),
 40‐49 year olds accounted for 18% (329),
 50‐59 year olds accounted for 4% (66),
 Teenagers (13‐19 years) represented 2% (39),
 Age 60 years and above accounted for less than 1% (13), and
 3 of the cases did not have an age of diagnosis reported.
22% of all
HIV/AIDS cases
diagnosed in
Oklahoma
are IDU.
Of the 29 new
IDU cases
diagnosed in
2009, 62% were
IDU only.
38% of newly
diagnosed IDU
cases in 2009
were
MSM and IDU.
0
10
20
30
40
50
60
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 20. HIV/AIDS Cases by Diagnosis Year for
Injection Drug Users*, Oklahoma 2000‐2009
IDU
MSM
&IDU
* Includes IDU and MSM & IDU
33
HIV/STD Service
Oklahoma State
Department of Health
Since 2000, there has been a 66% decrease of HIV/AIDS cases among newly
diagnosed persons classified as IDU or MSM &IDU.
 Among IDU only, there has been a 68% decrease of newly diagnosed
HIV/AIDS cases in Oklahoma since 2000.
 Among MSM & IDU, there has been a 61% decrease of newly diagnosed
HIV/AIDS cases since 2000.
By Gender
 Of new cases diagnosed in 2009, males accounted for 76% of cases, while
females accounted for 24% of cases.
 In 2000, males accounted for 71% of IDU cases and females accounted for
29% of cases.
Unknown <13 13‐19 20‐29 30‐39 40‐49 50‐59 60+
0
100
200
300
400
500
600
700
800
900
Age at Diagnosis
Number of Cases
Chart 21. Cumulative HIV/AIDS Cases Among IDU*
By Age Group, Oklahoma 2009
*Includes IDU and MSM & IDU
34
By Race and Ethnicity
Of those diagnosed in 2009 (29), and classified as IDU or MSM & IDU:
 Whites accounted for 69%,
 Blacks accounted for 17% ,
 Hispanics accounted for 7%, and
 American Indian and Alaska Natives accounted for 7%.
 All other races did not have any IDU cases.
Of the 1,788 IDU cases diagnosed in Oklahoma since 1982:
 Whites accounted for 68% (1,218),
 Blacks accounted for 16% (292),
 American Indians and Alaska Natives accounted for 9% (162),
 Hispanics accounted for 5% (87)
 And all other races accounted for less than 2% combined.
0
20
40
60
80
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 22. HIV/AIDS Cases Among Injection Drug
Users* by Year and Gender, Oklahoma 2009
*Includes IDU and MSM & IDU Male Female
Of cumulative
IDU cases, males
accounted for
82%.
In 2009, zip codes
73118 and
73107 had the
largest
percentage of
IDU cases.
35
HIV/STD Service
Oklahoma State
Department of Health
Geographic Distribution in Oklahoma
 Five counties in Oklahoma accounted for 70% of the cumulative HIV/AIDS cases
diagnosed in Oklahoma: Oklahoma (614), Tulsa (413), Cleveland (122),
Comanche (50), and Canadian Counties (35).
 The top five zip codes for IDU cases living with HIV/AIDS in the Oklahoma City
and Tulsa areas were as follows:
1. 73112
2. 73106
3. 73118
4. 74112
5. 74110
White
69%
Black
17%
Hispanic
7%
AI/AN
7%
Chart 23. New HIV/AIDS Cases Diagnosed Among
Injection Drug Users*, Oklahoma 2009
*Includes IDU and MSM & IDU
36
Overview
Since 1982, there have been 1,169 cases of HIV/AIDS diagnosed in Oklahoma
females. Of those cases, 655 (56%) were AIDS cases and 514 (44%) were HIV cases.
At the end of 2009, 71% (828) of the female cases were still living. In 2009, 57 cases
of HIV/AIDS were diagnosed among females at a rate of 3 per 100,000 population,
which was an 18% decrease in cases since 2000. Although there was an overall
decrease in female HIV/AIDS cases, there was a 39% increase in HIV only cases in
females.
By Age Group
The age group breakdown of cumulative HIV/AIDS cases diagnosed in Oklahoma
females are as follows:
 20‐29 year olds accounted for 35% (404),
 30‐39 year olds accounted for 34% (394),
 40‐49 year olds accounted for 19% (216),
 Teenagers (13‐19 years) represented 6% (69),
 50‐59 year olds accounted for 5% (59), and
 Age 60 years and above accounted for less than 3% (27).
Since 2000, age group 13‐19 years had a large increase in cases, however, only
accounted for 14% (8) of total cases diagnosed among females in 2009.
There has been a
39% increase in
HIV only cases in
females
since 2000.
Since 2000,
HIV/AIDS cases in
Oklahoma
females 13‐19
years old have
increased
100%.
Black females
have had a 26%
increase in cases
since 2000.
0
10
20
30
40
50
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 24. HIV/AIDS Cases by Diagnosis Year for
Females*, Oklahoma 2000‐2009
AIDS
HIV
* Females Age 13 and Above
37
HIV/STD Service
Oklahoma State
Department of Health
By Race and Ethnicity
Of those females newly diagnosed with HIV/AIDS in 2009 (57):
 39% were White,
 42% were Black,
 11% were American Indian or Alaska Native,
 7% were Hispanic, and
 Less than 2% were Asian or Pacific Islander.
Of the 1,169 female cases diagnosed in Oklahoma since 1982:
 Whites accounted for 53% (620),
 Blacks accounted for 29% (340),
 American Indians and Alaska Natives accounted for 8% (97),
 Hispanics accounted for 6% (73),
 Two or more races accounted for 3% (30), and
 Asian/Pacific Islander accounted for less than 1% combined (9).
13‐19 20‐29 30‐39 40���49 50‐59 60+
0
100
200
300
400
500
Age at Diagnosis
Number of Cases
Chart 25. Cumulative HIV/AIDS Cases Among
Females* By Age Group, Oklahoma 2009
*Females age 13 and above AIDS HIV
38
By Mode of Transmission
Since 1982, cumulative HIV/AIDS cases diagnosed in females were classified as
follows:
 Heterosexual (46%),
 IDU (27%),
 Unknown (23%),
 Blood or blood products (2%), and
 Other (less than 1%).
Of newly diagnosed HIV/AIDS cases in 2009:
 12% were classified as IDU,
 39% were classified as heterosexual contact, and
 49% were unknown (NRR or NIR).
Geographic Distribution in Oklahoma
 Six counties in Oklahoma accounted for 75% of the newly diagnosed female
HIV/AIDS cases in Oklahoma: Oklahoma (16), Tulsa (11), Osage (6), Cleveland (4),
Rogers (3), and Payne (3).
 The top four zip codes for female cases living with HIV/AIDS in the Oklahoma City
and Tulsa areas were as follows:
1. 73111
2. 74106
3. 73106
4. 74136
White
39%
Black
42%
Hispanic
7% AI/AN
10%
Asian/PI
2%
Chart 26. New HIV/AIDS Cases Diagnosed Among
Females by Race/Ethnicity,* Oklahoma 2009
*Females age 13 and above
Black women
have a rate 8
times higher than
white women.
Since 2000, the
number of IDU
cases among
females has
decreased 71%.
AI/AN and
Hispanic women
have a rate 2
times higher than
white women.
39
40
41
What are the patterns of service utilization
of HIV infected persons in Oklahoma?
42
Overview
The Ryan White Treatment and Modernization Act provides funding for HIV care for the
majority of HIV infected clients in the United States. Ryan White (RW) is the payer of last
resort and, consequently, serves indigent clients with no other means of obtaining medical
care or psychosocial support. A disproportionate number of individuals who receive Ryan
White care and treatment services are on the margins of society and include minorities,
women, and individuals with substance abuse and mental illness. Funding of Ryan White
programs is categorized by Parts A‐F, each of which provides funding for specific purposes.
The OSDH HIV Treatment and Care Division is currently receiving Part B funding. There is
no Part A funding in Oklahoma because it is considered a low incidence State. There are
two Part C Early Intervention Services (EIS) clinics in Oklahoma:
 University of Oklahoma (OU) Health Sciences Center Infectious Disease Clinic in
Oklahoma City, and
 Oklahoma State University (OSU) Internal Medicine Special Services in Tulsa.
In Oklahoma, there is one Part D program, also located at the University of Oklahoma
Health Sciences Center in Oklahoma City.
The Ryan White Program at the Oklahoma State Department of Health provides a vast array
of services to HIV positive clients who meet income and eligibility guidelines. These services
include primary specialty care, oral healthcare, mental health treatment, HIV medication
assistance, health insurance assistance, medical transportation services, medical and non‐medical
case management, and outpatient substance abuse treatment.
Oklahoma is funded by Part B of the Ryan White Treatment and Modernization Act. A large
portion of Part B funding in Oklahoma is directed toward life‐sustaining HIV medications
through the AIDS Drug Assistance Program, or the Oklahoma HIV Drug Assistance Program
(HDAP) and Health Insurance Assistance Program (HIAP).
HIV Drug Assistance Program (HDAP)
HDAP is a statewide prescription assistance program administered through the Oklahoma
State Department of Health by a contract with the drug wholesaler, Cardinal, and the
dispensing pharmacy, OU Pharmacy Care Center, which provides specific HIV related
medications to eligible low‐income individuals living with HIV disease in Oklahoma. The
HDAP drug formulary has increased from 47 drugs in 2003 to 156 currently in 2010,
including all FDA approved HIV antiretroviral therapies. Funding for HDAP comes primarily
from the federal Ryan White CARE Act Part B grant to the state.
RW Part A
Provides funding
to metropolitan
areas most
affected by the
HIV epidemic
RW Part B
Provides funding
to state health
departments for
HIV care
RW Part C
Funds individual
medical facilities
that care for HIV
infected clients
RW Part D
Funds services
for women and
children
43
HIV/STD Service
Oklahoma State
Department of Health
HIV Insurance Assistance Program (HIAP)
The HIV Insurance Assistance Program is a statewide program providing assistance with
continuation of health insurance premium payments for those eligible low‐income
individuals living with HIV disease in Oklahoma who have health insurance plans that
qualify for the program. This program was first implemented in October of 2001 and
continues to increase in utilization. Nearly doubling clients served in 2006, 311 individuals
received insurance assistance in 2009.
There has been a consistent increase in the number of individuals served through the
HDAP, co‐pay assistance, and health insurance assistance program each year. Since 2000,
there has been a 111% increase in the total HDAP assistance (HDAP only, co‐pay, and
health insurance) per month to 1,398 clients served per month in fiscal year (FY) 2009.
0
200
400
600
800
1000
1200
1400
1600
1996 2000 2006 2007 2008 2009
Number of Clients
Fiscal Year
Chart 27. Total Clients Served in Oklahoma
by Fiscal Year and Program
Insurance Assistance Co‐Pay Assistance Total HDAP
44
By continuing insurance premiums and assisting clients with co‐pays, the program saves
money. The average cost per client on insurance assistance was $233 per month versus
$959 per month for a client who does not have insurance and obtains prescriptions through
the drug assistance program alone. The ODSH requires clients eligible for Medicare D
prescription assistance, O‐EPIC (Insure Oklahoma) and other forms of insurance to enroll in
these plans to reduce costs per client. This also benefits the client by providing access to
insurance for medical appointments in addition to prescription access.
RW Part F
Funds AIDS
Education and
Training Centers
(AETC), Dental
Reimbursement,
and Special
Projects of
National
Significance
(SPNS)
Oklahoma
received
$3,618,532
for RW Part B
Funding for 2009
In 2009, the
OSDH was
funded
$4,268,335
for ADAP
0
200
400
600
800
1000
1996 2000 2006 2007 2008 2009
Clients Served
Fiscal Year
Chart 28. Average Clients Served in Oklahoma Per
Month by Fiscal Year and Program
Insurance Assistance Co‐Pay Assistance HDAP
0
500
1000
1500
1996 2000 2006 2007 2008 2009
Number of Clients
Fiscal Year
Chart 29. Average Cost Per Client by Fiscal Year
and Program, Oklahoma
Insurance Assistance Co‐Pay Assistance HDAP
45
HIV/STD Service
Oklahoma State
Department of Health
More importantly, by continuing insurance for clients and paying for prescriptions, the
HDAP program is able to improve health outcomes as well. In 2004, only 50% of clients had
undetectable viral loads that were enrolled in some form of assistance, but in 2009 63%
had undetectable viral loads. The longer a client has been on ART, the more the viral load
decreases and overall health improves. In 2009, 89% of HDAP clients who were on ART for
3 years or more had undetectable viral loads as compared to only 53% who had been on
ART for 1 year or less.
53%
78%
89%
0%
20%
40%
60%
80%
100%
<=1 1 to 2 3 or more
% Undetectable
Years on Regimen
Chart 30. Percent of Clients with Undectable Viral
Loads by Length of Time on ART Regimen, FY09
46
Overview
Included in the HIV/STD Service is the Division of HIV/STD Prevention and Intervention
(DPI). The division receives federal funds for both HIV and STD prevention through Centers
for Disease Control and Prevention (CDC) and has over twenty highly trained and educated
professionals to provide these services. This division is responsible for disease investigation
of newly reported HIV and syphilis, and facilitates all medical referral services for anyone
who has been infected with or exposed to HIV or STDs. This division also provides oversight
of all funded and non‐funded HIV testing sites in Oklahoma, as well as, training and
education in HIV counseling, risk reduction, and STD prevention to community partners and
consumers.
DPI has several health education and training staff who facilitate trainings and educational
opportunities throughout Oklahoma. Some of these trainings include: HIV 101 Seminar;
HIV Counseling, Testing and Referral; STD 101 Seminar; RESPECT; and Bridging Theory and
Practice. The OSDH also supports and coordinates trainings such as Community
Identification, Diffusion of Effective Behavioral Intervention (DEBI) programs, and other
prevention strategies and projects.
Counseling, Testing and Referral Services (CTR)
Currently, DPI contracts with five CBOs to provide HIV CTR services for high risk
Oklahomans. These CTR sites are located in Oklahoma City and Tulsa. DPI also supports 14
sites throughout the state to provide CTR through the donation of laboratory services to
confirm preliminary positive results. The funded CTR sites include: Red Rock Behavioral
Health Services, RAIN Oklahoma, Health Outreach Prevention Education, Inc. (HOPE), and
Guiding Right, Inc. (GRI) Oklahoma City and Tulsa locations.
Health Education and Risk Reduction (HE/RR)1
 Community PROMISE (Peers Reaching Out and Modeling Intervention Strategies) is a
community‐level intervention which the OSDH supports through a contract with HOPE
in Tulsa. This intervention promotes progress toward consistent HIV prevention
practices through community mobilization and distribution of small media materials and
risk reduction supplies, such as condoms.
 CRCS (Comprehensive Risk Counseling and Services) formerly PCM, is an intensive,
individualized client‐centered counseling intervention for adopting and maintaining HIV
risk‐reduction behaviors. CRCS is designed for HIV‐positive and HIV‐negative individuals
who are at high risk for acquiring or transmitting HIV and STDs and struggle with issues
such as substance use and/or abuse, physical and mental health, and social and cultural
factors that affect HIV risk. DPI maintains inter‐agency agreements with the Oklahoma
State University (OSU) Center for Health Sciences Internal Medicine Specialty Services
and the University of Oklahoma (OU) Health Sciences Center Infectious Disease Institute
to provide CRCS.
OSDH HIV
Prevention
Budget awarded
from CDC
$2,440,850
OSDH CTR
Supplemental
Prevention
Budget awarded
$112,085
23,719 HIV
tests were
conducted by
OSDH CTR sites
1 HE/RR descriptions were provided by Centers for Disease Control and Prevention.
47
HIV/STD Service
Oklahoma State
Department of Health
 Many Men, Many Voices (3MV) is a group‐level intervention that addresses behavioral
and social factors influencing the HIV risk behaviors of Black MSM. This multi‐session
intervention uses a menu of behavior change options for HIV prevention. The
intervention addresses factors that influence the behavior of black MSM: cultural, social,
and religious norms; the relationship between HIV and other sexually transmitted
diseases; sexual relationship dynamics; and the social influences that racism and
homophobia have on HIV risk behaviors. 3MV is offered by GRI in Oklahoma City and is
supplemented with additional funding from OSDH DPI.
 Partner, Counseling, and Referral Services (PCRS) is offered to anyone identified as
infected with HIV or syphilis. Eleven Disease Intervention Specialists (DIS) and two Front
Line Supervisors are on staff to provide these services throughout the state. DIS are
responsible for interviewing the infected patients, identifying partners and/or
associates, follow‐up with partners and/or associates for appropriate testing, and
providing referrals for treatment and management of infection.
48
Overview
xPEMS is a web‐based, secure data collection and reporting system specifically for HIV
Counseling , Testing, and Referral services. Oklahoma’s xPEMS database collects the same
data required by the CDC’s Program Evaluation Monitoring System (PEMS). PEMS is a
nation‐wide initiative of the CDC to ensure standardized data collection and evaluation
methods for HIV prevention service provision. All OSDH HIV prevention contractors must
collect and report program planning, budget, and client‐level and aggregate data through
the database.
In Oklahoma, there are currently 90 county health department facilities entering data into
xPEMS along with 5 funded CBO’s and 14 unfunded CBO’s. The newly identified positivity
rates by facilities are as follows: County Health Departments 0.30%, funded CBO’s 1.06%,
and unfunded CBO’s 1.62%. The goal for newly identified positives is a rate of 1.0%.
There were 23,719 tests performed in 2009.
 11,321 were females (rate of 607 per 100,000 population);
 12,385 were males (rate of 680 per 100,000 population).
Of all tests performed, 131 were diagnosed and identified as newly identified positives.
 24 were among females (rate of 1.3 per 100,000 population);
 107 were among males (rate of 5.9 per 100,000 population).
During 2009, two counties in Oklahoma accounted for almost 75% of the newly identified
positives:
 Oklahoma 38.9% (51) and
 Tulsa 35.1% (46).
By Age Group
The age groups for all newly identified positives in 2009 are as follows:
 13‐19 year olds accounted for 7%,
 20‐29 year olds accounted for 37%,
 30‐39 year olds accounted for 29%,
 40‐49 year olds accounted for 18%,
 50‐59 year olds accounted for 8%, and
 Age 60 years and above accounted for 1%.
There are 109
sites in Oklahoma
entering data
into xPEMS.
The Oklahoma
CTR newly
identified
positivity rate for
2009 was
0.55%.
Blacks had a CTR
HIV positivity rate
almost 6 times
higher than
Whites.
49
HIV/STD Service
Oklahoma State
Department of Health
By Race and Ethnicity
 Among racial and ethnic groups, Blacks (26.4 cases per 100,000 population)
had the highest rate of new HIV/AIDS cases for 2009.
 Hispanics had the second highest rate (7 cases per 100,000 population).
 Whites had a rate of 4.5 cases per 100,000 population.
 American Indians/Alaskan Natives had a rate of 4.1 cases
per 100,000 population.
 Asian/Pacific Islanders had a rate of 3.3 cases per 100,000 population.
By Mode of Transmission
 57.3% (75) were classified as men who have sex with men (MSM),
 8.4% (11) were classified as heterosexual sex with someone HIV positive,
 4% (5) were classified as injection drug use (IDU),
 2.3% (3) were classified as MSM & IDU, and
 28% (37) were classified as no reported risk or no identified risk.
Table 7. Top 3 Counties of Newly Identified HIV Counseling, Testing,
and Referral in Oklahoma for 2009
By Number of Cases By Rate per 100,000
1 Oklahoma Roger Mills
2 Tulsa Tulsa
3 Cleveland Oklahoma
50
51
What are the number and characteristics
of Oklahomans who know they are HIV‐positive
but who are not receiving HIV primary care?
52
Overview
Although the Ryan White program serves a large proportion of HIV‐positive low‐income
individuals in Oklahoma, a huge gap still exists for clients who know their HIV status but do
not access primary medical care. States are required to estimate the number of HIV/AIDS
clients that are not receiving primary medical care (unmet need) every 2 years. These
individuals not receiving primary medical care are defined as “out‐of‐care.” States are
encouraged to identify demographic characteristics of the unmet need population.
The Oklahoma unmet need project involved two primary goals:
1. Estimate unmet need using the HRSA definition.
2. Assess the demographic characteristics of those in and out‐of‐care in Oklahoma.
Out‐of‐care (unmet need) was defined as no CD4, viral load, or evidence of ART from
January 1, 2008 through December 31,2008. In care (met need) was defined as having
either a CD4, viral load, or evidence of ART from January 1, 2008 through December 31,
2008. Analysts cross‐matched eHARS with client‐level data sources of care patterns and
death indexes, including: RW CAREWare, Medicaid, HDAP, HIAP, PHIDDO (Public Health
and Disease Detection System of Oklahoma), medical provider chart reviews, and death
certificates.
Unmet Need Facts in Oklahoma
 Forty‐six percent of HIV positive/AIDS clients living in Oklahoma were out‐of‐care in
2008.
 Blacks and Hispanics were more likely to be out‐of‐care than other racial/ethnic
groups.
 Injection Drug Users (IDUs) were more likely to be out‐of‐care than other risk factor
groups.
 Youth were more likely to be out‐of‐care than other age groups.
 The Lawton MSA and Non‐MSA or Rural areas were more likely to be out‐of‐care
than other geographic areas.
 HIV only cases were more likely to be out‐of‐care than AIDS cases.
Table 8. Care Status by Diagnosis
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
Diagnosis
In Care
Number (%)
Out‐of‐care
Number (%)
Total
Number (%)
HIV 1,299 (44%) 1,624 (56%) 2,923 (100%)
AIDS 2,075 (61%) 1,308 (39%) 3,383 (100%)
Total 3,374 (54%) 2,932 (46%) 6,306 (100%)
HRSA
Health
Resources and
Services
Administration
HRSA defines
HIV/AIDS cases
based on current
residence;
CDC defines
HIV/AIDS cases
by residence at
time of diagnosis.
In 2006,
approximately
43% of persons
living with
HIV/AIDS in the
United States
were out‐of‐care.
53
HIV/STD Service
Oklahoma State
Department of Health
Table 9. Care Status by Race/Ethnicity
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
Race/Ethnicity
Number (%)
In Care Out of Care Total
White 2,088 (54%) 1,760 (46%) 3,848 (100%)
Black 713 (49%) 741 (51%) 1,454 (100%)
Hispanic 227 (48%) 245 (52%) 472 (100%)
Asian/Pacific Islander 23 (51%) 22 (49%) 45 (100%)
American Indian/Alaska Native 229 (63%) 136 (37%) 365 (100%)
Table 10. Care Status by Diagnosis Location,
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
MSA
Number (%)
In Care Out of Care Total
OKC MSA 1,340 (61%) 872 (39%) 2,212 (100%)
Tulsa MSA 819 (57%) 615 (43%) 1,434 (100%)
Lawton MSA 62 (34%) 119 (66%) 181 (100%)
Ft. Smith MSA 37 (60%) 25 (40%) 62 (100%)
NON‐MSA 1,116 (46%) 1301 (54%) 2,417 (100%)
Table 11. Care Status by HIV Diagnosis Age,
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
Age Group
Number (%)
In Care Out of Care Total
1‐12 27 (53%) 24 (47%) 51 (100%)
13‐19 105 (44%) 131 (56%) 236 (100%)
20‐24 484 (50%) 479 (50%) 963 (100%)
25‐29 641 (53%) 578 (47%) 1,219 (100%)
30‐39 1,292 (54%) 1,098 (46%) 2,390 (100%)
40‐49 632 (58%) 462 (42%) 1,094 (100%)
50‐59 158 (56%) 125 (44%) 283 (100%)
60+ 33 (60%) 22 (40%) 55 (100%)
54
55
What is the scope of sexually transmitted
diseases in Oklahoma?
56
Overview
Chlamydia is the most commonly reported notifiable sexually transmitted disease (STD) in
the United States. Caused by the bacterium Chlamydia trachomatis, it also is the most
prevalent STD in Oklahoma, accounting for 74% of reported STDs for 2009.
Oklahoma had an incidence rate of 407 per 100,000 in 2009 with 74% of the reported cases
being female, matching the general gender trend since 1997. Since 1997, the gender gap
has increased slightly, though both genders saw an increase in the number of Chlamydia
cases. Generally, women go to the doctor more frequently than men, due to yearly exams
and pregnancy related appointments; therefore, this could account for disparity among
genders.
Up to 70% of
women with
chlamydia do not
have signs or
symptoms.
Oklahoma
mandated
chlamydia
reporting in
1988, when
2,714 cases
were reported.
In 2009, a total
of 14,991 cases
were reported.
0
100
200
300
400
500
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate per 100,0000 population
Year of Diagnosis
Chart 31. Rates of Chlamydia for
Oklahoma vs. United States, 2000‐2009
U.S Oklahoma
0
2,000
4,000
6,000
8,000
10,000
12,000
2000 2001 2002 2003 2004 2005 2006 2007 *2008 *2009
Numbre of Cases
Year of Diagnosis
Chart 32. Reported Chlamydia Cases in Oklahoma
by Gender, 2000‐2009
*Reports available electronically Male Female
57
HIV/STD Service
Oklahoma State
Department of Health
Chlamydia by Age Group
 Chlamydia occurs in all ages, but age groups 15‐19 years (2,101 per 100,000) and 20‐ 24
years (2,031 per 100,000) had the highest rates among all the age groups in 2009.
 The 20‐24 year age group (5,702 cases) and the 15‐19 age group (5,397 cases) have the
highest number of reported cases.
 Oklahomans ages 20‐24 have consistently had the highest number of cases since 2004.
 Of the 15‐19 years age group, 19 year olds (1,735 cases) have consistently reported the
highest number of cases among all age groups since 1997.
 In 2009, those 18 years old had the second highest number of cases followed by those
20 years old. Both the 18 (1,588 cases) and 20 (1,552 cases) year old age groups have
reported the second or third highest case numbers since 1997.
 Most of the reported Chlamydia cases in Oklahoma since 1997 have been 15 years of
age or older.
Chlamydia by Race
 The Black population had the highest rate among all racial groups with a rate of 1,526
per 100,000, 7 times higher when compared to the White population (220 per
100,000).
 American Indians and Alaska Natives had the second highest rate (505 per 100,000)
which was 2.3 times higher than Whites.
 Asian and Pacific Islanders had a rate of 1,621 per 100,000, but had only 64 cases in
2009 (47% increase from 2008).
0
1000
2000
3000
4000
5000
6000
7000
White Hispanic Black Asian/PI AI/AN
Number of Cases
Race/Ethnicity
Chart 33. Chlamydia Cases by Race/Ethnicity,
Oklahoma 2009
58
 Hispanics had a rate of 414 per 100,000 in 2009, which represents a 17% increase from
2008.
 Though the Black and White populations have both seen an increase in rates/cases
since 1999, the White population has consistently had more reported cases during the
specified time period.
 White females (4,837 cases) reported the highest number of cases in 2009, followed by
Black females (2,933 cases), which follows the general trend since 1997.
 Black males (1,598 cases) reported the third highest total in 2009, followed by
American Indian and Alaska Native females (1,239 cases).
Geographic Distribution of Chlamydia in Oklahoma
 Oklahoma County (4,185 cases) had the highest number of reported Chlamydia cases in
2009, followed by Tulsa (3,357 cases) and Comanche (1,032 cases) Counties.
 Comanche County had the highest rate at 911 per 100,000 population, followed by
Oklahoma county (584 per 100,000), and Tulsa County (559 per 100,000).
 Lawton had the highest ranked zip code (73505) for Chlamydia cases in the state.
 There are 4 major Metropolitan Statistical Areas (MSA) in Oklahoma with the majority
of the Chlamydia morbidity coming from the Oklahoma City MSA, followed by the Tulsa
and the Lawton MSAs.
 The 405 area code reported the most Chlamydia cases compared to the 918 area code
in 2009, which follows the same trend since 1997, though the gap has gotten
increasingly larger.
The rate of
Chlamydia in
Oklahoma
increased 4.4%
between 2008
and 2009, which
follows a trend in
Oklahoma and
the U.S. since
1997.
Oklahoma City
had the highest
number of
reported
Chlamydia cases
in 2009, followed
by Tulsa and
Lawton.
59
60
Overview
Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply in
warm, moist areas of the reproductive tract, mouth, throat, eyes, and anus. In women,
gonorrhea can result in pelvic inflammatory disease, ectopic pregnancy, cervicitis, and
eventually infertility. Pregnant women infected with gonorrhea can also infect their
unborn babies through the amniotic fluid or during birth. In men, this infection most often
manifests as purulent urethral discharge and dysuria, and can cause infertility.
Gonorrhea cases increased from 1943 until 1982, when numbers started to slowly drop
following a national decline due to the implementation of a national gonorrhea control
program in the mid‐1970s. The rate of gonorrhea in Oklahoma decreased 6% between 2008
and 2009, which follows a trend of relatively stable gonorrhea morbidity in Oklahoma and
the United States since 1997. Oklahoma had an incidence rate of 126 per 100,000 in 2009,
with 60% of the reported cases being female. In 1989, men made up the majority of
gonorrhea cases in the U.S, but since 2002 women have made up the majority of cases with
Oklahoma following a similar trend.
Oklahoma 1st
mandated
gonorrhea
reporting in
1943, when
4,715 cases
were reported.
Gonorrhea is the
2nd most
reported STD in
Oklahoma.
In 2009, a total of
4,661 cases
were reported in
Oklahoma.
0
50
100
150
200
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate per 100,000 Population
Year of Diagnosis
Chart 34. Gonorrhea Rates per 100,000 Population,
Oklahoma vs. U.S. 2000‐2009
U.S Oklahoma
**US Data for 2009 not available at time of this report.
61
HIV/STD Service
Oklahoma State
Department of Health
Gonorrhea by Race
 Blacks had the highest rate among all racial groups in 2009 with a rate of 849 per
100,000, 20 times higher when compared to the White population (42 per
100,000).
 American Indians and Alaska Natives had the second highest rate (111 per 100,000)
which was 2.6 times higher than Whites.
 Asian/Pacific Islanders had a rate of 279 per 100,000, but represented only 11 cases
in 2009 (a 46% increase from 2008).
 Hispanics had a rate of 64 per 100,000 in 2009, which represents a 7.8% increase
from 2008.
 Black Oklahomans had the highest decrease in gonorrhea rate, an 11.2% decrease
from 2008.
 Since 1997, there has been a slight increase in the White population and a slight
decrease in the Black population for the number of reported gonorrhea cases in
Oklahoma, though the Black population still reports much higher numbers.
 From 1997 to 2008 Black males reported the highest number of gonorrhea cases
followed by Black females with White females reporting the third most cases.
However, in 2009 Black females reported the highest number of cases followed by
Black males.
0 200 400 600 800 1000 1200
AI/AN
Black
White
Asian/PI
Multi
Hispanic
State Total
Rates per 100,000 population
Race/Ethnicity
Chart 35. Reported Gonorrhea Rates per 100,000
population by Race/Ethnicity, Oklahoma 2008‐2009
2008 RATE /100,000 2009 RATE /100,000
62
Since 1997, most
of the gonorrhea
cases diagnosed
were among
15‐24 year olds.
In 2009, Blacks
has the highest
rate among all
races.
Choctaw
County had the
highest rate of
gonorrhea in
2009.
Gonorrhea by Age Group
 Gonorrhea occurs in all ages, but age groups 15 to 19 years (533 per 100,000) and
20 to 24 years (593 per 100,000) had the highest rates among all age groups.
 Although most age groups had a rate decrease from 2008 to 2009, the 10 to 14 age
group had the only rate increase at 21 per 100,000, 12% higher than 2008 (44 to 50
cases).
 In 1997, Oklahomans ages 15 to 19 years had the highest number of cases. But
since 1999, Oklahomans ages 20 to 24 years have consistently reported higher
numbers, a trend similar to that for Chlamydia.
 Of all ages, 19 year olds have consistently seen a higher number of reported cases
since 1998, followed by the 20 year olds.
 Of all ages, 18 and 20 year old age groups have both been second and third for
number of reported gonorrhea cases, a trend similar to Chlamydia.
0
200
400
600
800
10‐14 15‐19 20‐24 25‐29 30‐34 35‐39 40‐44 45‐49
Rate
Age Group
Chart 36. Reported Gonorrhea by Age Group,
Oklahoma 2008‐2009
2009 RATE /100,000 2008 RATE /100,000
0
1,000
2,000
3,000
4,000
2000 2001 2002 2003 2004 2005 2006 2007 *2008 *2009
Number of Cases
Year of Diagnosis
Chart 37. Reported Gonorrhea Cases in Oklahoma
by Gender, 2000‐2009
*Reports available electronically Male Female
63
HIV/STD Service
Oklahoma State
Department of Health
Geographic Distribution of Gonorrhea in Oklahoma
 While Oklahoma county had the highest number of reported cases, Choctaw
county had the highest rate at 275 per 100,000, followed by Oklahoma county (246
per 100,000), and Tulsa county (244 per 100,000).
 Choctaw County had a 44% rate increase between 2008 and 2009, while Oklahoma
County decreased by 14%, and Tulsa County increased by 2.6%.
 There are 4 major Metropolitan Statistical Areas (MSA) in Oklahoma, with the
majority of the gonorrhea morbidity coming from the Oklahoma City MSA, followed
by the Tulsa and the Lawton MSAs.
 Oklahoma is also split into 3 area codes, each containing a major city with the 405
area code containing Oklahoma City (Oklahoma county), the 918 area code
containing the city of Tulsa (Tulsa county), and the 580 area code containing the
city of Lawton (Comanche county).
 The 405 area code reported the most gonorrhea cases compared to the 918 area
code in 2009. This follows the same trend since 1997 though the gap has
decreased.
 The city of Tulsa had the highest number of reported gonorrhea cases in 2009
followed by Oklahoma City and Lawton, with Tulsa having 2 out of the top three zip
codes for gonorrhea cases in the state (including the highest ranked zip code).
64
Overview
The development of ARG is a growing public health concern, in particular because
only one remaining class of antibiotics is recommended for its treatment. Currently,
the CDC recommends that cephalosporin antibiotics be used to treat all gonococcal
infections in the United States. Historically, gonorrhea has progressively developed
resistance to the antibiotic drugs prescribed to treat it. These drugs include
penicillin, tetracycline, and ciprofloxacin. Thus, it is critical to continuously monitor
antibiotic resistance of gonorrhea, and encourage research and development of new
treatment regimens.
Surveillance
Surveillance for ARG and the establishment of gonococcal treatment guidelines in
the United States are conducted through the GISP, which was established in 1986.
Approximately 25‐30 sites, and 4‐5 regional laboratories across the U.S. participate
in GISP, and data from this project have been reported and have directly contributed
to CDC's STD Treatment Guidelines since 1989. Oklahoma County is a participating
GISP site.
Trends
Overall in 2008, 24% of isolates collected from 29 GISP sites were resistant to
penicillin, tetracycline, ciprofloxacin, or some combination of those antibiotics. In
1993, ciprofloxacin, along with ceftriaxone and cefixime (drugs that are types of
cephalosporins) were among the recommended treatments for gonorrhea. However,
in the late 1990s and early 2000s, ciprofloxacin resistance began to arise in Hawaii
and the West Coast of the continental U.S.
By 2004, ciprofloxacin resistance was elevated in men who have sex with men
(MSM). In 2006, 13.8% of isolates exhibited resistance to ciprofloxacin. Ciprofloxacin
resistance was present in all regions of the country, including the heterosexual
population. On April 13, 2007, CDC stopped recommending fluoroquinolones as
treatment for gonococcal infections for all persons in the United States.
Susceptibility testing for the cephalosporin class of drugs is currently being
conducted by GISP on ceftriaxone, cefixime, and cefpodoxime.
ARG
Antimicrobial
Resistance in
Neisseria
gonorrhoeae
GISP
Gonococcal
Isolate
Surveillance
Project
65
HIV/STD Service
Oklahoma State
Department of Health
Challenges
A major challenge to monitoring emerging antimicrobial resistance in gonorrhea is
the substantial decline in capability of laboratories to perform essential gonorrhea
culture techniques required for antibiotic susceptibility testing. This decline results
from an increased use of newer laboratory technology such as a diagnostic test
called the Nucleic Acid Amplification Test (NAAT), which is not culture‐based.
Currently, there is no reliable technology that allows for antibiotic susceptibility
testing from non‐culture specimens and increased laboratory culture capacity is
needed.
Information provided by Centers for Disease Control and Prevention‐ Division of STD Prevention.
66
Overview
Syphilis is a sexually transmitted disease (STD) caused by the bacteria Treponema
Pallidum. Syphilis is transmitted from person to person through direct contact with a
syphilis lesion. Symptoms of syphilis differ according to the disease stage. Many people
have no symptoms for years, yet remain at risk for complications if not treated.
There are three stages of syphilis infection: primary, secondary, and latent. The latent
stage of syphilis can be divided into early latent, late latent, and unknown duration.
During primary syphilis infection, an ulcer (called chancre ["shan‐ker"]) typically appears
within 10 to 90 days (an average 21 days) after exposure. These chancres usually
disappear within a few weeks whether treated or not.
Symptoms of secondary syphilis are a rash of lesions anywhere on the body (including the
palms of the hands and soles of the feet), along with broad‐based papules (lumps or
warts) in warm, moist sites. Mucous patches or snail‐track ulcers (sores) can develop in
the mouth, appearing several weeks after the chancre develops. Flu‐like symptoms can
also occur during secondary syphilis. Up to 15% of individuals with untreated syphilis
may develop latent syphilis from 10 to 20 years after the initial infection.
The latent stage of syphilis begins when primary and secondary symptoms disappear;
these final stages can last for years. If left untreated, an infected person will continue to
have syphilis although there are no signs or symptoms. During the final stages of syphilis,
the disease may damage the internal organs, including the brain, heart, blood vessels,
bones, and joints. Signs and symptoms of the late stage of syphilis include paralysis,
blindness, dementia, and even death. Neurosyphilis can occur during any stage of
syphilis. In this article, early syphilis is defined as a case of primary, secondary, or early
latent syphilis.
In 2009, there
were a total of
263 reported
early syphilis
cases in
Oklahoma.
The syphilis rate
in Oklahoma
increased
16.2% between
2008 and 2009.
The Oklahoma
County rate was
3.1 times higher
than the state
rate.
0
2
4
6
8
10
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate per 100,000 Population
Year of Diagnosis
Chart 38. Early Syphilis Rates per 100,000
Population, Oklahoma vs. U.S. 2000‐2009
*US Data for 2009 not available as time of this report. U.S Oklahoma
**Early Syphilis is defined as primary, secondary, and early latent syphilis.
67
HIV/STD Service
Oklahoma State
Department of Health
Although Oklahoma saw an increase over the past year, there has been an overall
decrease since 1997 in Oklahoma and the United States.
 Oklahoma had an incidence rate of 7 per 100,000 in 2009 with 60.9% of the
reported cases being male.
 Oklahoma County had the highest number of reported cases and the highest rate
at 22 per 100,000.
 Comanche County had the second highest rate (14.1 per 100,000) followed by
McCurtain County (12 per 100,000).
 Comanche County had the highest rate increase of all the counties in Oklahoma.
Early Syphilis by Age Group
 Syphilis occurs in all ages, but age groups 20‐24 years (21.7 per 100,000) and 25‐ 29
years (18.9 per 100,000) had the highest rates among all the age groups in 2009.
 The 20‐24 year age group and the 15‐19 age group had the highest number of
reported cases.
 In 2009, 69% of the early syphilis cases were between the ages of 20 and 39, with 44%
between the ages of 20 and 29.
 Age group 45‐49 year had the biggest decrease from 2008 (56.2%).
 The 20 year old age group reported the second highest number of cases among all
age groups in 2009.
 Most age groups had an increase from 2008 to 2009 with the 35 to 39 age group
having the highest rate increase, 34% higher than 2008 (21 to 32 cases).
 In 1997, persons 27 and 28 years of age reported the highest number of cases.
0
5
10
15
20
25
15���19 20‐24 25‐29 30‐34 35‐39 40‐44 45‐49 50+
Rate
Age Group
Chart 39. Reported Early Syphilis* by Age Group,
Oklahoma 2008‐2009
2009 RATE /100,000 2008 RATE /100,000
*Early Syphilis includes Primary, Secondary, and Early Latent Syphilis.
68
Those 24 years
old reported the
highest
number of cases
among all age
groups in 2009.
Black males have
consistently
reported the
highest
number of cases
since 1997.
The Comanche
County rate
increased 68%
from 2008 to
2009.
Early Syphilis by Race
 The Black, White, and American Indian and Alaska Native populations in Oklahoma
reported 95% of the syphilis cases in 2009.
 Blacks had the highest rate among all racial groups for early syphilis with a rate of
41.4 per 100,000 population, 11 times higher when compared to the Whites (3.62 per
100,000).
 American Indian and Alaska Natives had the second highest rate (5.74 per 100,000)
which was 1.6 times higher than Whites.
 Hispanics had a rate of 8.28 per 100,000 in 2009, which represents a 13% decrease
from 2008.
 Blacks reported the biggest increase from 2008 (28%), while the American Indian and
Alaska Natives reported the biggest decrease (13.6%).
 In 2009, Black males (74) reported the most cases followed closely by White males
(68).
Geographic Distribution of Early Syphilis in Oklahoma
 Oklahoma includes 77 counties, with Oklahoma county having the highest number of
reported early syphilis cases in 2009, followed by Tulsa and Comanche counties.
 Oklahoma County had the highest rate at 22 per 100,000 population, followed by
Comanche County (14.1 per 100,000) and McCurtain County (12 per 100,000).
 The majority of early syphilis cases (62%) were reported from Oklahoma County.
 The 405 area code reported the most early syphilis cases, which follows the same
trend since 1997.1
 Oklahoma City had the highest number of reported syphilis cases in 2009 followed by
Tulsa and Lawton, with Oklahoma City having the highest ranked zip code (73107) for
syphilis cases in the state.
1The 580 and 405 area codes have been combined for this analysis and are both collectively called the 405 area code.
0
10
20
30
40
50
AI/AN Black White Hispanic
Rate
Race
Chart 40. Early Syphilis Rate per 100,000
by Race/Ethnicity, Oklahoma 2008‐2009
2009 Rate 2008 Rate
69
70
Overview
During 2009, Oklahoma experienced a syphilis outbreak in Oklahoma County. In
March of 2009, three high school students between the ages of 15 to 17 were
reported to the Oklahoma City County Health Department with early syphilis. Within
days, another 17 year old was reported with primary syphilis in the central Oklahoma
area. Upon further investigation, the reporting county health department nurse
stated her county had seen a few cases of early syphilis among teens the previous
week.
By August of 2009, there were a total of 36 cases in the outbreak. Twenty‐two of
these cases were diagnosed as early latent syphilis with 9 secondary syphilis cases, 4
primary syphilis cases, and 1 late latent syphilis case. The majority (58%) of the cases
were among males. Blacks accounted for 67% of the outbreak, followed by Whites
(33%) and Hispanics (11%). Although the first outbreak cases were among 15‐17
year olds, the outbreak age ranged from 14 ‐45 years of age with a median age of 21
years.
Heterosexual contact was identified as the only risk activity for 42% of those involved
in the outbreak. Men who have sex with men accounted for 30% of the outbreak
cases. The additional 28% had a risk identified as a combination of heterosexual
contact, sex while intoxicated or high, anonymous sex, or bisexual contact.
Outbreak Response
The OSDH HIV/STD Service deployed all DIS to Oklahoma County to ensure proper
timelines were achieved. Health educators from the HIV Prevention and
Intervention Division worked directly with the Oklahoma Department of Education,
local county health departments, and the Oklahoma School Nurses Association to
increase education and awareness of STDs to area teens. The Oklahoma Health Alert
Network (OKHAN) was also used to provide information to physicians and emergency
departments across Oklahoma.
A press release was also issued to alert the public. This press release resulted in 13
interviews and five follow‐up stories broadcasted on local media stations across
Oklahoma. Presentations were provided to local community partners and
organizations, including affected high schools. Four DIS and two health educators
performed onsite screening and counseling services at a popular hangout named by
multiple positive youth.
March 25, 2009
Press Release
“The Oklahoma
State Department
of Health
announced today
that it has
identified an
outbreak of
syphilis occurring
among teenagers
younger than age
18 in the central
Oklahoma area.”
71
HIV/STD Service
Oklahoma State
Department of Health
Table 12. Oklahoma Syphilis Outbreak
Investigation In 2009
Number Percent
Gender
Male 22 61%
Female 14 39%
Race
Black 24 67%
White 12 33%
Ethnicity
Hispanic 4 11%
Non‐Hispanic 32 89%
Mode of Transmission
Heterosexual Only 15 42%
MSM 11 30%
Combination 10 28%
*Combination is defined as two or more of the following: heterosexual, sex
while high or intoxicated, anonymous sex, or bisexual females.
72
Overview
In 2009, 43 Oklahomans were diagnosed with both HIV/AIDS and syphilis. This was a
major increase since 2000, when only nine cases were diagnosed. Of the 43 cases
diagnosed, 30 (70%) were classified as HIV and 13 (30%) were classified as AIDS.
Forty‐four percent (19) of cases had a syphilis diagnosis of latent syphilis, followed
by 42% (18) of secondary syphilis, and 14% (6) of primary syphilis.
The majority of cases were male (93%), with only 7% being female. Age group 20‐29
year olds accounted for 58% of the cases, followed by 40‐49 year olds (16%), and 30‐
39 year olds (12%). Age group 13‐19 year olds accounted for 9% and 50‐59
accounted for 5% of the co‐morbidity cases.
 While Whites (40%) made up the largest percentage of cases, Blacks (35%) and
Hispanics (19%) also accounted for a significant amount . Persons of multi‐race
and American Indians/Alaska Natives accounted for less than 7% combined.
 Oklahoma, Comanche, and Tulsa Counties were the top three counties for co‐morbidity
of HIV/AIDS and Syphilis, with Oklahoma County accounting for 41% of
the cases.
 The top four zip codes with co‐morbidities are as follows (in order): 73107,
73505, 73106, and 73120.
Since 2000, there
has been almost
a 400% increase
in co‐morbidity
cases of HIV and
Syphilis.
MSM and MSM &
IDU accounted
for 77% of the
cases.
0
2
4
6
8
10
12
14
White Black Hispanic AI/AN Multi
Number of Cases
Race/Ethnicity
Chart 41. HIV/AIDS and Syphilis Co‐morbidity Cases
by Race and HIV Diagnosis, Oklahoma 2000‐2009
AIDS
HIV
*AI/AN ‐ American Indian/Alaska Native
73
74
Acute Hepatitis B
2009 Case Total:
122
Acute Hepatitis B
2009 Rate:
3.3 per 100,000
Hepatitis B
vaccine has been
available since
1982.
Overview
Hepatitis B is a virus that enters the bloodstream and then infects the liver. It is most
often spread from person to person through contact with infected semen, vaginal
secretions, or blood. Symptoms of hepatitis B may be mild or very severe and include
being very tired, nausea, vomiting, fever, stomach pain, and yellowing of the skin and
eyes. It can take anywhere from two to six months after exposure before the
symptoms of infection appear, however about 30% of infected people do not
develop symptoms and may not know they are infected.
Most adults with hepatitis B will get rid of the virus within four to six months and are
no longer capable of giving the infection to others. However, about 1 out of every 10
infected adults, and as many as 9 out of 10 babies will become chronically infected
with hepatitis B, which means they do not get rid of the virus. Most chronically
infected persons do not look or feel sick. However, they may eventually develop
serious liver diseases such as cirrhosis (scarring) or liver cancer.
For the second year in a row, acute hepatitis B cases in Oklahoma decreased by 5.4%
from 2008 to 2009, from 129 cases to 122 cases. The continuation of the Hepatitis
Vaccine Initiative—a collaborative effort between OSDH, the Oklahoma Department
of Corrections, and the Centers for Disease Control—may be a factor in the reduction
of reported cases. The OSDH has also partnered with a metro area medical clinic for
the homeless to provide combination hepatitis A/B vaccines to a high risk
population.
By Gender
 64 (52%) were males and
 48 (48%) were female.
By Race
 79 Whites (2.8 per 100,000),
 24 American Indians and Alaska Natives (8.2 per 100,000),
 6 Black or African Americans (2.1 per 100,000),
 2 Asians (3.1 per 100,000),
 1 Hawaiian/Other Pacific Islander (25.9 per 100,000), and
 10 cases reported as Unknown race.
By Risk Factor
 64 (52%) reported a risk factor of 2 or more sexual partners.
 38 (31%) reported more than 5 sexual partners.
75
HIV/STD Service
Oklahoma State
Department of Health
Perinatal Hepatitis B
In 2009, a total of 95 babies were born to hepatitis B surface antigen positive women
in Oklahoma. This was a 42% increase from 2008, with 67 live births. There are
several likely explanations for this increase—
 better disease reporting as more laboratories are submitting their results
electronically;
 a greater awareness of the disease; and
 an increase in persons from areas where the disease is endemic (ex: Sub‐
Saharan Africa and Southeast Asia).
According to Oklahoma’s population demographics, the CDC estimated that
Oklahoma should have had approximately 160 cases reported in 2009. Oklahoma
will most likely see the number of deliveries to hepatitis B positive women continue
to increase in the future. Although it is alarming, chronic cases of hepatitis B have
remained fairly constant. The way to decrease the future cases is to increase
awareness and vaccinate infants appropriately.
The CDC recommends a “universal birth” dose policy for all delivery hospitals. In
Oklahoma, there were 76 delivery hospitals and only 50% of them had a universal or
a standing order for administration of hepatitis B vaccine to infants before discharge.
It is recommended that infants born to hepatitis B positive women be given hepatitis
B immune globulin (HBIG) and hepatitis B vaccine within 12 hours of birth.
During 2009 in Oklahoma,
 77% of babies born received both injections within 12 hours,
 85% received both injections within 24 hours, and
 92% received both injections within 48 hours of birth.
 52% of infants had received HBIG and all three hepatitis B vaccines by 12
months of age.
 21% of the reported infants were serologically tested by 15 months of age.
The ages of the women who were hepatitis B surface antigen positive and who
delivered infants ranged from 16 to 44 years. Fifty‐eight percent of delivering women
were between 30 and 40 years of age. Thirty‐nine percent were between 20 and 30
years of age and three percent were under 20 years of age.
76
2009 Acute
Hepatitis C
Case Total: 27
2009 Acute
Hepatitis C
Case Rate:
0.7 per 100,000
Oklahoma Acute
Hepatitis C
Incidence Rate is
2 times higher
than the US
average.
Overview
Hepatitis C can be either classified as acute or chronic, but the CDC currently collects
only reports of acute hepatitis C infection. The acute (newly acquired) form is a
short‐term illness that occurs within the first 6 months after a person is exposed to
the hepatitis C virus (HCV) which causes hepatitis C; however, the disease can
become chronic. Of 100 HCV‐infected people, 75 to 85 will develop chronic (long‐lasting)
infection and 70 people will eventually develop chronic liver disease.
Although less than 3% of chronically infected persons die as a result of their
infection, hepatitis C remains the leading indication for liver transplantation.
People who received a blood transfusion before 1992, as well as, past or current
injection‐drug users, are at risk for chronic hepatitis C and should be screened for the
disease. Chronic HCV infection progresses slowly over the course of a 15‐30 year
period and can lead to cirrhosis of the liver or liver cancer. Eight thousand to ten
thousand deaths occur annually in the United States as a result of chronic HCV
infection.
For 2009, there was a 29% increase of confirmed cases of acute hepatitis C, from 21
cases in 2008 to 27 cases in 2009. Based on the most current CDC data, 2007,
Oklahoma’s case rate (0.7 per 100,000) is above the national rate (0.3 per 100,000)
for confirmed cases of acute hepatitis C. In Oklahoma, currently HCV case
investigation is limited to cases in persons 40 years of age and younger.
Demographics
 Cases of acute hepatitis C ranged in age from 18 years to 54 years.
 Eleven (41%) of the total cases were located in three large metropolitan
counties—Oklahoma, Tulsa and Cleveland.
 The highest number of cases, 12 (44%), occurred among 25‐34 year olds.
 Age groups of the remaining cases were as follows:
o 1(3%) 18 years of age,
o 2 (7%) 20 to 24 years,
o 7 (26%) 35 to 44 years, and
o 5 (19%) 45 to 54 years.
 There were 15 females (56%) and 12 males (44%) infected with confirmed
acute hepatitis C.
 The confirmed acute hepatitis C cases broken down by race were:
o Whites 20 (0.7 per 100,000),
o American Indian and Alaska Natives 4 (1.4 per 100,000), and
o Unknown race 3.
77
HIV/STD Service
Oklahoma State
Department of Health
CDC states that “of the cases reported in 2007 for which information concerning
exposures during the incubation period was available, the most common risk factor
identified was IDU (48%). During 1998–2007, IDU was reported for an average of
44% of persons (range: 38%–54%)”.
The risk factors most frequently reported in the 2009 Oklahoma cases were:
 IDU (52%),
 Other drug use besides IDU (48%),
 Tattoos (59%), and
 2 or more sexual partners (37%).
Eighteen (67%) of the cases reported at least 2 or more of the most frequently
reported risk factors needed.
Information provided by Centers for Disease Control and Prevention‐ Division of STD Prevention.
White
74%
AI/AN
15%
Unknown
11%
Chart 42. Confirmed Acute Hepatitis C Cases
In Oklahoma for 2009
78
Overview
In 2009, 36 Oklahomans had been diagnosed with both HIV/AIDS and Hepatitis B or
C. The majority (75%) were diagnosed with Hepatitis C (past or present), followed by
19% Chronic Hepatitis B, and 6% Acute Hepatitis B.
Eighty‐three percent of cases were males, and 17% were females. Forty‐six percent
of cases were MSM, 18% were MSM & IDU, 21% were IDU, and 3% were
heterosexual. Twelve percent of cases had an unknown risk.
Whites (69%) accounted for the largest percent of co‐morbidity cases, followed by
Blacks (22%), American Indians/Alaska Natives (6%), Hispanics (6%), and unknown
race (3%).
The age group breakdown of HIV/AIDS and Hepatitis B/C co‐morbidity are as follows:
 30‐39 year olds accounted for 45% (16),
 40‐49 year olds accounted for 28% (10),
 Age 50 and above accounted for 19% (7), and
 20‐29 year olds accounted for 8% (3).
Geographic Distribution in Oklahoma
 Oklahoma (10) and Tulsa (6) counties accounted for almost half (44%) of the co‐morbidity
cases.
 The top two Oklahoma cities with the largest number of co‐morbidity cases were
Oklahoma City (8) and Tulsa (7).
Acute Hep B
6%
Chonic
Hep B
19%
Hep C
75%
Chart 43. HIV/AIDS Cases Newly Diganosed with
Hepatitis B or C, Oklahoma 2009
Co‐Morbidity
is defined as the
presence of one
or more diseases.
64% of cases
were either MSM
or MSM & IDU.
Oklahoma males
accounted for the
majority of
cases.
79
80
81
82
Table 1. Prevalence (Persons Living) Estimates for HIV/AIDS Cases,
Rates by County, Oklahoma 2009
COUNTY
HIV CASES AIDS CASES
Number Rate Number Rate
Adair 4 18.30 7 32.03
Alfalfa * 17.97 * 17.97
Atoka 3 20.59 8 54.90
Beaver * * * 19.08
Beckham 7 32.57 3 13.96
Blaine 10 78.94 7 55.26
Bryan 13 32.13 16 39.54
Caddo 26 88.65 15 51.14
Canadian 41 38.41 47 44.03
Carter 13 27.24 14 29.34
Cherokee 6 13.14 13 28.47
Choctaw 8 53.75 6 40.31
Cimarron * * * *
Cleveland 160 66.51 108 44.89
Coal * 17.63 * 35.26
Comanche 143 127.40 49 43.65
Cotton * 15.96 * 31.91
Craig 5 33.11 11 72.84
Creek 22 31.65 22 31.65
Custer 9 34.26 8 30.45
Delaware 4 9.89 7 17.30
Dewey * 45.29 * 45.29
Ellis * * * *
Garfield 23 39.62 19 32.73
Garvin * 7.37 10 36.86
Grady 17 33.27 17 33.27
Grant * * * 22.48
Greer 4 68.73 4 68.73
Harmon * * * 35.29
Harper * 29.54 * *
Haskell * 8.15 6 48.92
Hughes 4 29.35 3 22.01
Jackson 6 23.68 9 35.52
Jefferson 4 64.20 3 48.15
Johnston 4 38.36 3 28.77
Kay 18 39.23 13 28.33
Kingfisher 3 21.03 * 14.02
Kiowa * * 3 32.45
Latimer * 9.46 4 37.82
Le Flore 20 40.16 22 44.17
Lincoln 7 21.83 9 28.06
Logan 25 65.06 17 44.24
Love 3 32.98 * 21.99
83
1. Cells represented by an asterisk (*) are not reported due to privacy concerns.
2. Rates have been calculated per 100,000 population using the 2008 US Census Data. 2009 Census Data was not available at the time
this table was created.
McClain 8 24.63 15 46.17
McCurtain 8 23.89 10 29.86
McIntosh 5 25.47 7 35.66
Major 3 42.06 * *
Marshall 5 33.43 * 13.37
Mayes 4 9.98 11 27.44
Murray * 7.82 * 7.82
Muskogee 23 32.51 32 45.23
Noble 7 63.64 * 9.09
Nowata 3 27.97 4 37.30
Okfuskee 3 27.01 7 63.02
Oklahoma 955 135.25 925 131.00
Okmulgee 8 20.46 15 38.36
Osage 16 35.40 27 59.73
Ottawa 8 25.28 9 28.44
Pawnee 5 30.66 9 55.18
Payne 25 31.75 21 26.67
Pittsburg 12 26.80 16 35.73
Pontotoc 9 24.36 8 21.65
Pottawatomie 21 30.23 33 47.51
Pushmataha * 8.57 * 17.14
Roger Mills * * * *
Rogers 27 31.97 20 23.68
Seminole 9 37.33 6 24.89
Sequoyah 11 26.77 15 36.51
Stephens 9 20.76 10 23.07
Texas 8 38.89 4 19.44
Tillman * 12.61 * 12.61
Tulsa 637 107.53 701 118.33
Wagoner 11 15.93 10 14.48
Washington 6 11.87 16 31.65
Washita * 8.55 * *
Woods * 11.93 * *
Woodward 5 25.34 4 20.27
Unknown 5 * * *
STATE OF OKLAHOMA 2,483 68.14 2,441 66.99
84
Table 2. Estimated Distribution of Newly Diagnosed HIV/AIDS cases in Oklahoma for 2009
COUNTY 2008 Population Est. Cases
Rate/100,000
Population
State 3,644,025 312 8.56
Adair 21,857 * 0.00
Alfalfa 5,565 * 0.00
Atoka 14,573 * 0.00
Beaver 5,242 * 0.00
Beckham 21,494 * 0.00
Blaine 12,668 * 0.00
Bryan 40,463 3 7.41
Caddo 29,329 3 10.23
Canadian 106,755 12 11.24
Carter 47,716 * 0.00
Cherokee 45,667 * 0.00
Choctaw 14,885 * 13.44
Cimarron 2,585 * 0.00
Cleveland 240,568 20 8.31
Coal 5,672 * 0.00
Comanche 112,249 11 9.80
Cotton 6,267 * 0.00
Craig 15,101 * 13.24
Creek 69,514 6 8.63
Custer 26,272 * 3.81
Delaware 40,463 * 2.47
Dewey 4,416 * 0.00
Ellis 3,877 * 0.00
Garfield 58,053 * 3.45
Garvin 27,128 3 11.06
Grady 51,099 * 3.91
Grant 4,448 * 0.00
Greer 5,820 * 17.18
Harmon 2,834 * 0.00
Harper 3,385 * 0.00
Haskell 12,266 * 0.00
Hughes 13,630 3 22.01
Jackson 25,336 * 7.89
Jefferson 6,231 * 0.00
Johnston 10,428 * 9.59
Kay 45,886 * 4.36
Kingfisher 14,264 * 7.01
Kiowa 9,246 * 0.00
85
Latimer 10,576 * 0.00
Le Flore 49,806 4 8.03
Lincoln 32,070 * 3.12
Logan 38,424 8 20.82
Love 9,097 * 10.99
McClain 32,487 * 0.00
McCurtain 33,489 * 2.99
McIntosh 19,629 * 5.09
Major 7,132 * 0.00
Marshall 14,958 * 6.69
Mayes 40,084 * 0.00
Murray 12,787 * 7.82
Muskogee 70,750 * 2.83
Noble 11,000 * 0.00
Nowata 10,725 * 0.00
Okfuskee 11,107 * 9.00
Oklahoma 706,116 102 14.45
Okmulgee 39,100 * 0.00
Osage 45,203 16 35.40
Ottawa 31,644 * 3.16
Pawnee 16,310 * 0.00
Payne 78,733 4 5.08
Pittsburg 44,776 4 8.93
Pontotoc 36,948 * 2.71
Pottawatomie 69,464 4 5.76
Pushmataha 11,672 * 0.00
Roger Mills 3,370 * 0.00
Rogers 84,464 7 8.29
Seminole 24,110 * 0.00
Sequoyah 41,089 * 4.87
Stephens 43,351 * 0.00
Texas 20,573 * 0.00
Tillman 7,928 * 0.00
Tulsa 592,406 68 11.48
Wagoner 69,040 * 2.90
Washington 50,556 * 0.00
Washita 11,691 * 0.00
Woods 8,379 * 0.00
Woodward 19,729 * 0.00
Unknown 0 * 0.00
STATE OF OKLAHOMA 3,644,025 312 8.56
1. Cells represented by an asterisk (*) are not reported due to privacy concerns.
2. Rates have been calculated per 100,000 population using the 2008 US Census Data. 2009 Census Data was not available at the time
this table was created.
86
Table 3. Reportable Sexually Transmitted Diseases by County, Oklahoma 2009
COUNTY
CHLAMYDIA GONORRHEA EARLY SYPHILIS
Number Rate Number Rate Number Rate
Adair 69 316 6 28 * *
Alfalfa 4 71 * * * *
Atoka 51 348 9 61 * *
Beaver 10 191 * * * *
Beckham 103 487 14 66 * *
Blaine 21 166 * * * *
Bryan 168 419 23 57 * *
Caddo 97 334 10 34 * *
Canadian 202 190 50 47 4 3.8
Carter 165 344 36 75 * *
Cherokee 200 437 40 87 * *
Choctaw 81 544 41 275 * *
Cimarron * * * * * *
Cleveland 580 242 141 59 11 4.6
Coal 7 122 * * * *
Comanche 1,032 923 207 185 16 14.3
Cotton 21 339 * * * *
Craig 51 337 8 53 * *
Creek 202 289 49 70 * *
Custer 64 242 14 53 * *
Delaware 91 225 * * * *
Dewey 5 114 * * * *
Ellis 9 227 * * * *
Garfield 271 466 43 74 4 6.9
Garvin 56 206 9 33 * *
Grady 129 253 35 69 * *
Grant 4 90 * * * *
Greer 22 385 * * * *
Harmon 5 176 * * * *
Harper 6 182 * * * *
Haskell 24 197 * * * *
Hughes 33 242 9 66 * *
Jackson 115 456 20 79 * *
Jefferson 11 177 * * * *
87
Johnston 20 194 * * * *
Kay 66 145 9 20 * *
Kingfisher 28 196 4 28 * *
Kiowa 29 309 * * * *
Latimer 35 331 5 47 * *
Le Flore 155 311 20 40 4 8.*
Lincoln 74 230 11 34 * *
Logan 173 454 44 115 * *
Love 25 273 4 44 * *
Major 13 183 * * * *
Marshall 26 174 * * * *
Mayes 108 271 15 38 * *
Mcclain 62 192 15 46 * *
Mccurtain 173 516 47 140 4 11.9
Mcintosh 55 279 14 71 * *
Murray 23 180 * * * *
Muskogee 285 400 101 142 * *
Noble 21 188 6 54 * *
Nowata 20 186 * * * *
Okfuskee 29 260 7 63 * *
Oklahoma 4,185 592 1,738 246 158 22.4
Okmulgee 149 380 48 122 * *
Osage 84 185 14 31 * *
Ottawa 106 333 14 44 * *
Pawnee 38 233 9 55 * *
Payne 344 439 51 65 * *
Pittsburg 157 348 22 49 * *
Pontotoc 121 327 47 127 * *
Pottawatomie 249 358 53 76 * *
Pushmataha 13 111 * * * *
Roger Mills 6 176 * * * *
Rogers 177 210 29 34 * *
Seminole 79 326 27 112 * *
Sequoyah 139 339 9 22 * *
Stephens 107 246 20 46 * *
Texas 26 128 * * * *
Tillman 19 241 * * * *
Tulsa 3,367 569 1,444 244 26 4.4
88
Wagoner 109 158 29 42 * *
Washington 116 230 6 12 * *
Washita 12 102 * * * *
Woods 13 154 * * * *
Woodward 46 232 5 25 * *
STATE OF OKLAHOMA 14,991 412 4,661 128 256 7
1. Early Syphilis includes primary, secondary and early latent syphilis only.
2. Cells with less than 3 cases have been suppressed for confidentiality reasons.
3. Rates have been calculated per 100,000 population using the 2008 US Census Data. 2009 Census Data was not available at
the time this table was created.
89
Table 4. Cumulative HIV/AIDS Cases Diagnosed in Oklahoma
By Race/Ethnicity and Sex as of 2009
Race/Ethnicity Male Female Total
White 4,680 640 5,320
Black 1,359 344 1,703
Hispanic, All Races 394 75 469
Asian/Pacific Islander 32 10 42
American Indian/Alaska Native 422 100 522
Multiple Races 94 31 125
Table 5. Living HIV/AIDS Cases Diagnosed in Oklahoma
By Race/Ethnicity as of 2009
Race/Ethnicity AIDS HIV Total
White 1,476 1,497 2,973
Black 534 616 1,150
Hispanic, All Races 186 172 358
Asian/Pacific Islander 16 17 33
American Indian/Alaska Native 177 131 308
Multiple Races 52 50 102
90
Table 7. Top 3 Counties of Newly Diagnosed HIV Counseling, Testing, and
Referral in Oklahoma for 2009
By Number of Cases By Rate per 100,000
1 Oklahoma Roger Mills
2 Tulsa Tulsa
3 Cleveland Oklahoma
Table 6. Top Five Counties of Newly Diagnosed HIV/AIDS Cases
in Oklahoma for 2009
By Number of Cases By Rate per 100,000
1 Oklahoma Osage
2 Tulsa Hughes
3 Cleveland Logan
4 Osage Oklahoma
5 Canadian Tulsa
*Counties with less than 3 cases were removed from the analysis for confidentiality reasons.
91
Table 8. Care Status by Diagnosis
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
Diagnosis In Care
Number (%)
Out of Care
Number (%)
Total
Number (%)
HIV 1,299 (44%) 1,624 (56%) 2,923 (100%)
AIDS 2,075 (61%) 1,308 (39%) 3,383 (100%)
Total 3,374 (54%) 2,932 (46%) 6,306 (100%)
Table 9. Care Status by Race/Ethnicity
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
Race/Ethnicity
Number (%)
In Care Out of Care Total
White 2,088 (54%) 1,760 (46%) 3,848 (100%)
Black 713 (49%) 741 (51%) 1,454 (100%)
Hispanic 227 (48%) 245 (52%) 472 (100%)
Asian/ Pacific Islander 23 (51%) 22 (49%) 45 (100%)
American Indian/ Alaska Native 229 (63%) 136 (37%) 365 (100%)
92
Table 10. Care Status by Diagnosis Location,
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
MSA
Number (%)
In Care Out of Care Total
OKC MSA 1,340 (61%) 872 (39%) 2,212 (100%)
Tulsa MSA 819 (57%) 615 (43%) 1,434 (100%)
Lawton MSA 62 (34%) 119 (66%) 181 (100%)
Ft. Smith MSA 37 (60%) 25 (40%) 62 (100%)
NON‐MSA 1,116 (46%) 1301 (54%) 2,417 (100%)
Table 11. Care Status by HIV Diagnosis Age,
HIV/AIDS Cases Living in Oklahoma as of December 31, 2008
Age Group
Number (%)
In Care Out of Care Total
1‐12 27 (53%) 24 (47%) 51 (100%)
13‐19 105 (44%) 131 (56%) 236 (100%)
20‐24 484 (50%) 479 (50%) 963 (100%)
25‐29 641 (53%) 578 (47%) 1,219 (100%)
30‐39 1,292 (54%) 1,098 (46%) 2,390 (100%)
40‐49 632 (58%) 462 (42%) 1,094 (100%)
50‐59 158 (56%) 125 (44%) 283 (100%)
60+ 33 (60%) 22 (40%) 55 (100%)
93
Table 12. Oklahoma Syphilis Outbreak Investigation In 2009
Number Percent
Gender
Male 22 61%
Female 14 39%
Race
Black 24 67%
White 12 33%
Ethnicity
Hispanic 4 11%
Non‐Hispanic 32 89%
Mode of Transmission
Heterosexual Only 15 42%
MSM 11 30%
Combination 10 28%
*Combination is defined as two or more of the following: heterosexual, sex while high or intoxicated, anonymous
sex, or bisexual females.
94
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
White Black American
Indian
Asian/Pacific
Islander
Other Multiple
Race
Number of People
Race Group
Chart 1. Race Distribution of People
in Oklahoma for 2009*
*2009 American Community Survey 1‐Year Estimates
0
100,000
200,000
300,000
400,000
500,000
600,000
0‐9 10‐14 15‐19 20‐24 25‐34 35‐44 45‐54 55‐64 65+
Number of People
Age Group (in years)
Chart 2. Age Distribution of People
in Oklahoma for 2009*
*2009 American Community Survey 1‐Year Estimates
95
0
50,000
100,000
150,000
200,000
250,000
300,000
Less than
$15K
$15K to
$24K
$25K to
$34K
$35K to
$49K
$50K to
$74K
$75K to
$99K
$100K to
$149K
$150K to
$199K
$200K or
more
Number of People
Annual Income (in Dollars)
Chart 3. Income Distribution of People in
Oklahoma for 2009*
*2009 American Community Survey 1‐Year Estimates
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
9th to 12th
grade, no
diploma
High school
graduate
Some college,
no degree
Associate's
degree
Bachelor's
degree
Graduate or
professional
degree
Number of People
Educational Attainment
Chart 4. Education Distribution of People in
Oklahoma for 2009
*2009 American Community Survey 1‐Year Estimates
96
0
1000
2000
3000
4000
5000
6000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of cases
Year of Diagnosis
Chart 5. HIV and AIDS Cases Diagnosed in Oklahoma
by Year, Incidence vs. Prevalence for 1999 ‐2009
Incidence Prevelance
Unknown
12<
13‐19
20‐29
30‐39
40‐49
50‐59
60+
0 500 1000 1500 2000 2500 3000 3500
Age at Diagnosis
Number of Cases
Chart 6. Cumulative HIV/AIDS in Oklahoma as of 2009
97
0
20
40
60
80
100
120
140
160
180
200
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 7. New HIV/AIDS Cases Among Males by Race,
Oklahoma 2000‐2009
White
Black
Hispanic
AI/AN
Asian/PI
Multi
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Number of Cases
Mode of Transmission
Chart 8. New HIV/AIDS Cases Among Males
by Mode of Transmission, Oklahoma 2009
98
0
1000
2000
3000
4000
5000
6000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of cases
Year of Diagnosis
Chart 9. Living HIV and AIDS Cases Diagnosed in
Oklahoma by Year, New Cases vs. Total
Living for 2000‐2009
New Total
Unknown <13 13‐19 20‐29 30‐39 40‐49 50‐59 60+
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Age at Diagnosis
Number of Cases
Chart 10. HIV/AIDS Prevalence in Oklahoma
by Age Group as of 2009
99
0
50
100
150
200
250
300
350
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 11. HIV/AIDS Prevalence in Oklahoma
by Gender, 2009
Male Female
MSM
61%
IDU
8%
MSM/IDU
11%
Hetero
5%
Perinatal
0%
Blood Products
1% Unknown
14%
Chart 12. HIV/AIDS Prevalence Among Males
by Mode of Transmission, Oklahoma 2009
100
13‐19
6%
20‐29
33%
30‐39
30%
40‐49
20%
50‐59
10%
60+
1%
Chart 14. New Diagnoses of HIV/AIDS
in Oklahoma, 2009
0
50
100
150
200
250
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 13. HIV and AIDS Cases Diagnosed
in Oklahoma by Year, 1999 ‐2009
HIV cases AIDS cases
101
0
20
40
60
80
100
120
140
160
White Black Hispanic Asian/Pacific
Islander
AI/AN Multi‐Race
Number of Cases
Race/Ethnicity
Chart 15. New HIV/AIDS Cases by
Race and Gender, Oklahoma 2009
Male Female
0 25 50 75 100 125 150
MSM
IDU
MSM/IDU
Hetero
Unknown
Number of Cases Mode of Transmission
Chart 16. New HIV/AIDS Cases by Mode of Transmission
and Gender, Oklahoma 2009
Female Male
102
0
10
20
30
40
50
60
70
80
90
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 18. HIV/AIDS Cases Among Men Who Have Sex
with Men by Age Group, Oklahoma 2000‐2009
13 ‐ 19 yrs
20 ‐ 24 yrs
25 ‐ 29 yrs
30 ‐ 39 yrs
40 ‐ 49 yrs
50 ‐ 59 yrs
60 and over
* Includes MSM and MSM & IDU
0
20
40
60
80
100
120
140
160
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 17. HIV/AIDS Cases by Diagnosis Year for Men
Who Have Sex with Men*, Oklahoma 2000‐2009
AIDS
HIV
* Includes MSM and MSM & IDU
103
0
20
40
60
80
100
120
140
White Black Hispanic AI/AN Multi
Number of Cases
Race/Ethnicity
Chart 19. HIV/AIDS Cases Among Men Who Have Sex
With Men by Race/Ethnicity, Oklahoma 2000‐2009
2009
2004
2000
* Includes MSM and MSM & IDU
0
10
20
30
40
50
60
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases Year of Diagnosis
Chart 20. HIV/AIDS Cases by Diagnosis Year for
Injection Drug Users*, Oklahoma 2000‐2009
* Includes IDU and MSM & IDU IDU MSM & IDU
104
Unknown <13 13‐19 20‐29 30‐39 40‐49 50‐59 60+
0
100
200
300
400
500
600
700
800
900
Age at Diagnosis
Number of Cases
Chart 21. Cumulative HIV/AIDS Cases Among IDU*
By Age Group, Oklahoma 2009
*Includes IDU and MSM & IDU
0
10
20
30
40
50
60
70
80
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases
Year of Diagnosis
Chart 22. HIV/AIDS Cases Among Injection Drug Users*
by Year and Gender, Oklahoma 2009
*Includes IDU and MSM & IDU Male Female
105
White
69%
Black
17%
Hispanic
7%
AI/AN
7%
Chart 23. New HIV/AIDS Cases Diagnosed Among
Injection Drug Users*, Oklahoma 2009
*Includes IDU and MSM & IDU
0
5
10
15
20
25
30
35
40
45
50
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Cases Year of Diagnosis
Chart 24. HIV/AIDS Cases by Diagnosis Year for
Females*, Oklahoma 2000‐2009
AIDS HIV
* Females Age 13 and Above
106
13‐19 20‐29 30‐39 40‐49 50‐59 60+
0
50
100
150
200
250
300
350
400
450
Age at Diagnosis
Number of Cases
Chart 25. Cumulative HIV/AIDS Cases Among Females*
By Age Group, Oklahoma 2009
*Females age 13 and above AIDS HIV
White
39%
Black
42%
Hispanic
7%
AI/AN
10%
Asian/PI
2%
Chart 26. New HIV/AIDS Cases Diagnosed Among
Females by Race/Ethnicity,* Oklahoma 2009
*Females age 13 and above
107
0
200
400
600
800
1000
1200
1400
1600
1996 2000 2006 2007 2008 2009
Number of Clients
Fiscal Year
Chart 27. Total Clients Served in Oklahoma by
Fiscal Year and Program
Insurance Assistance Co‐Pay Assistance Total HDAP
0
100
200
300
400
500
600
700
800
900
1000
1996 2000 2006 2007 2008 2009
Clients Served
Fiscal Year
Chart 28. Average Clients Served in Oklahoma Per
Month by Fiscal Year and Program
Insurance Assistance Co‐Pay Assistance HDAP
108
0
200
400
600
800
1000
1200
1996 2000 2006 2007 2008 2009
Number of Clients
Fiscal Year
Chart 29. Average Cost Per Client by Fiscal Year
and Program, Oklahoma
Insurance Assistance Co‐Pay Assistance HDAP
53%
78%
89%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<1 1 to 2 3 or more
% Undetectable Years on Regimen
Chart 30. Percent of Clients with Undectable Viral Loads by
Length of Time on ART Regimen, FY09
109
0
50
100
150
200
250
300
350
400
450
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate per 100,0000 population
Year of Diagnosis
Chart 31. Rates of Chlamydia for
Oklahoma vs. United States, 2000‐2009
U.S Oklahoma
0
2,000
4,000
6,000
8,000
10,000
12,000
2000 2001 2002 2003 2004 2005 2006 2007 *2008 *2009
Numbre of Cases
Year of Diagnosis
Chart 32. Reported Chlamydia Cases in Oklahoma
by Gender, 2000‐2009
*Reports available electronically Male Female
110
0
1000
2000
3000
4000
5000
6000
7000
White Hispanic Black Asian/PI AI/AN
Number of Cases
Race/Ethnicity
Chart 33. Chlamydia Cases by Race/Ethnicity,
Oklahoma 2009
0
20
40
60
80
100
120
140
160
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate per 100,000 Population
Year of Diagnosis
Chart 34. Gonorrhea Rates per 100,000 Population,
Oklahoma vs. U.S. 2000‐2009
U.S Oklahoma
111
0 200 400 600 800 1000 1200
AI/AN
Black
White
Asian/PI
Multi
Hispanic
State Total
Rates per 100,000 population
Race/Ethnicity
Chart 36. Reported Gonorrhea Rates per 100,000
population by Race/Ethnicity, Oklahoma 2008‐2009
2008 RATE /100,000 2009 RATE /100,000
0
100
200
300
400
500
600
700
10‐14 15‐19 20‐24 25‐29 30‐34 35‐39 40‐44 45‐49
Rate
Age Group
Chart 35. Reported Gonorrhea by Age Group,
Oklahoma 2008‐2009
2009 RATE /100,000 2008 RATE /100,000
112
0
500
1,000
1,500
2,000
2,500
3,000
3,500
2000 2001 2002 2003 2004 2005 2006 2007 *2008 *2009
Number of Cases Year of Diagnosis
Chart 38. Reported Gonorrhea Cases in Oklahoma
by Gender, 2000‐2009
*Reports available electronically Male Female
0
1
2
3
4
5
6
7
8
9
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate per 100,000 Population
Year of Diagnosis
Chart 37. Early Syphilis Rates per 100,000 Population,
Oklahoma vs. U.S. 2000‐2009
U.S Oklahoma
*US Data for 2009 not available as time of this report.
**Early Syphilis is defined as primary, secondary,
and early latent syphilis.
113
0
5
10
15
20
25
15‐19 20‐24 25‐29 30‐34 35‐39 40‐44 45‐49 50+
Rate
Age Group
Chart 40. Reported Early Syphilis* by Age Group,
Oklahoma 2008‐2009
2009 RATE /100,000 2008 RATE /100,000
*Early Syphilis includes Primary, Secondary, and Early Latent Syphilis.
0
5
10
15
20
25
30
35
40
45
AI/AN Black White Hispanic
Rate per 100,000
Race
Chart 39. Early Syphilis Rate per 100,000 Population
by Race and Ethnicity, Oklahoma 2008‐2009
2009 Rate 2008 Rate
114
0
2
4
6
8
10
12
14
White Black Hispanic AI/AN Multi
Number of Cases
Race/Ethnicity
Chart 41. HIV/AIDS ans Syphilis Co‐morbidity Cases by
Race and HIV Diagnosis, Oklahoma 2000‐2009
*AI/AN ‐ American Indian/Alaska Native AIDS HIV
White
74%
AI/AN
15%
Unknown
11%
Chart 42. Confirmed Acute Hepatitis C Cases
In Oklahoma for 2009
115
Acute Hep B
6%
Chronic Hep B
19%
Hep C
75%
Chart 43. HIV/AIDS Cases Newly Diganosed with
Hepatitis B or C, Oklahoma 2009
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
132
Oklahoma State Department of Health
HIV/STD Service
1000 NE 10th Street
Oklahoma City, OK 73117-1299
405.271.4636
www.ok.gov/health